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Opening Up: Therapist Self-Disclosure in Theory, Research, and Practice

  • University of Waterloo and Renison University College


While most therapists report that they do disclose some information about themselves to their clients, therapist self-disclosure continues to be both controversial and nebulous in clinical theory, research, and practice. This article considers what makes therapist self-disclosure so challenging to define and study and provides an overview of the empirical and theoretical literature. It then concludes with a consideration of therapist self-disclosure in contemporary legal, ethical, and technological contexts of clinical work.
Opening Up: Therapist Self-Disclosure in Theory, Research,
and Practice
Margaret F. Gibson
Published online: 11 April 2012
Springer Science+Business Media, LLC 2012
Abstract While most therapists report that they do dis-
close some information about themselves to their clients,
therapist self-disclosure continues to be both controversial
and nebulous in clinical theory, research, and practice. This
article considers what makes therapist self-disclosure so
challenging to define and study and provides an overview
of the empirical and theoretical literature. It then concludes
with a consideration of therapist self-disclosure in con-
temporary legal, ethical, and technological contexts of
clinical work.
Keywords Self-disclosure Theory Practice research
Feminist practice Psychodynamic theories Humanistic
theories Sexuality Illness Disability Best practices
Ethics Common factors Reflexive practice
Therapist self-disclosure is extremely common, with over
90 % of practitioners reporting that they disclose infor-
mation about themselves to their clients at least occasion-
ally (Henretty and Levitt 2010). Every major practice
tradition has written about what constitutes ‘‘appropriate’
and ‘‘inappropriate’’ uses of therapist self-disclosure
(TSD), sometimes at length (Farber 2006; Weiner 1983;
Zur 2007). However, despite its near-universal application
and the considerable volume of writing addressing it, TSD
continues to be controversial in the practice literature.
In this paper, I examine some of the ways in which the
concept may be defined and the theoretical underpinnings
of these definitions. I go on to discuss the existing research
into the uses and effects of TSD, looking first at the chal-
lenges of conducting this research, then summarizing some
findings on who is using TSD, when, with whom, and with
what effects. This exploration considers the impact of
diverse social locations of therapists and clients. I then
examine how TSD is addressed in different practice theo-
ries, and how it connects to other ‘‘common factors’’ of
therapy and pan-theoretical ethical and legal responsibili-
ties. Finally, I consider the impact of the Internet on TSD in
the 21st century.
Research Practice and Self-Disclosure
How do we write or think about self-disclosure without
self-disclosing? Different research epistemologies have
varying assumptions about the self of the writer/researcher
in social work knowledge. Broadly speaking, the more
post-positivist or positivist research traditions posit that the
researcher’s beliefs should be transformed into clear,
a priori hypotheses, but that the research design should then
minimize the impact of the particular researcher with an
ideal of ‘‘replicability’’ (i.e. any other researcher would get
the same or similar findings with the same hypotheses and
design) (e.g. Singleton and Straits 2010). Then, when the
research is presented or published, post-/positivist
researchers seldom explicitly discuss the researcher’s
experience and location, beyond general statements about
the limitations of the sample or the terminological defini-
tions selected. In contrast, qualitative and interpretivist tra-
ditions of social work research usually assume that the
researcher is inextricably implicated throughout the research
M. F. Gibson (&)
Factor-Inwentash Faculty of Social Work, University of Toronto,
246 Bloor Street West, Toronto, ON M5S 1V4, Canada
Clin Soc Work J (2012) 40:287–296
DOI 10.1007/s10615-012-0391-4
process. As a result, researchers in these traditions usually
devote part of every publication or presentation to disclosing
their own relationship with the population(s) and issue(s)
at hand, and to their own impact on the process, a practice
known as ‘‘researcher reflexivity’’(e.g. Heron 2005;
Charmaz 2006).
Any consideration of research on TSD must then con-
sider multiple layers of self-disclosure in its definitions and
its measurement, including the author’s own perspective.
For the purposes of the present study, I take a postmodern,
feminist approach to this topic, more in line with qualita-
tive/interpretivist research traditions. I start from a belief
that TSD has multiple possible definitions and effects, and
these will shift depending on the subject positions of the
individuals, institutions, and traditions involved. I also
assume that individual therapists and researchers, including
myself, will not be able to identify all aspects of how our
own subject positions (including race, culture, gender,
sexuality, religion, disability, national origin, professional
affiliation, and so forth) influence our stance.
From this starting point, my particular location is rele-
vant to this paper. I am a social worker and doctoral stu-
dent. My experiences as a practitioner have been in a wide
variety of settings: women’s shelters, crisis hotlines, family
mental health programs, addiction/harm reduction treat-
ment programs, HIV service providers, outpatient hospital
clinics, and others. I approach the topic of TSD as someone
who has both been chastised by a supervisor for revealing
my lesbian identity to a client, and has also been required
to reveal this same identity to clients as a prerequisite to
working in another setting. My clinical practice has drawn
upon feminist, cognitive-behavioral, client-centered, anti-
oppressive, and narrative practice theories, among others. I
believe that I have self-disclosed to clients somewhat less
frequently than most of my colleagues in my previous work
settings, although I also believe that I disclosed with a
frequency in the ‘‘average’’ range. I am not currently
practicing as a therapist.
Those would be ‘‘professional’’ disclosures. Are ‘‘per-
sonal’’ disclosures also relevant? As I have already partially
disclosed, I have a female gender identity, and a lesbian/
queer sexual identity which I disclose and do not disclose
many times in the course of a day. I am thirty-six years old,
married, and have two children. I am also white, Canadian
and American (as a dual citizen) and have lived in Canada,
the US, and France. I am English-speaking, able-bodied,
formally educated, and middle-class (in origin and in cur-
rent experience). I wrote my first paper on TSD as part of
my master’s degree in 2000, and have since had an abiding
interest in the topic. Depending on the reader, any and all of
this information may, or may not, be deemed relevant to a
consideration of TSD. Some of these disclosures may pro-
voke an emotional response in the reader, whether positive,
negative, or mixed. One of the challenges of self-disclosure
is the very unpredictability implied in determining what
another person may or may not want to know, and what the
effects of this information may be (Roberts 2005).
Definition and Epistemology of Therapist
Historically, the early discussions of TSD were limited and
definitive, starting with Freud’s stated caution: ‘‘The doctor
should be opaque to his patients, and like a mirror, should
show them nothing but what is shown to him’’ (1912,
p. 117; see Farber 2006;Zur2007 for more on Freud and
self-disclosure). Under Freudian and traditional analytic
definitions of self-disclosure, the analyst should remain
‘neutral’’ and not reveal any personal information or
opinions, only reflect and interpret what the client brought
to the encounter. While Freud may not have practiced what
he preached, nor intended his statements to inspire such
rigid adherence, under this tradition any further disclosure
of the therapist’s self would have been necessarily counter-
productive and, possibly, a sign of the therapist’s defi-
ciency and countertransference (Farber 2006; Weiner
1983; Zur 2007; Bloomgarden and Mennuti 2009c).
However, such an admonition against self-disclosure
presupposes that self-disclosure can be avoided. In the
years since Freud’s writing, social psychologists and others
have questioned the belief, not only that we can entirely
avoid communicating any information about ourselves, but
also that we can know exactly what and when we are
disclosing (Zur 2007; Farber 2006). Models such as the
Johari window, as created by Joseph Luft and Harry Ing-
ham, unsettle such assumptions (Farber 2006). In this
model, information about the self is categorized in one of
four quadrants: Open (known to all, self and others),
Hidden (known to self but not others), Blind (known to
others but not to self), or Unknown (hidden from self and
others). Of course, as a simplified model, the Johari win-
dow presumes both a monolithic, unchanging Self and a
monolithic, unchanging Other. Relationships, disclosures,
and awareness all change over time. Additionally, a ther-
apeutic relationship is but one relationship in two people’s
lives, and thus some information may be ‘‘Hidden’’ in one
relationship that is ‘‘Open’’ in others. In fact, it is a pre-
supposition of therapy that qualities of a particular rela-
tionship (e.g. the therapeutic alliance) will, over time,
influence what information falls into which categories:
hidden or disclosed, known or unknown, to the self as well
as to others. From the therapist’s perspective on self-dis-
closure, no school of practice advocates totally uniform
levels of disclosure across all domains of personal and
professional life!
288 Clin Soc Work J (2012) 40:287–296
Nevertheless, the Johari window provides a useful cor-
rective to many imprecise admonitions on TSD. To simply
state that a therapist should never self-disclose to a client
would not make sense in this model, since it theorizes that we
are all disclosing information about ourselves all the time,
whether or not we are aware of it. This model also suggests
that when we ask a therapist about her/his uses of self-dis-
closure, we need to simultaneously account for both the
limitations on what this therapist knows s/he has previously
disclosed to clients (awareness) and the limitations on what
s/he is now disclosing to us as researchers/questioners about
this past behavior (trustworthiness). To complicate matters
further, TSD is not always verbal. In addition to the thera-
pist’s facial expressions and body language, what the ther-
apist wears and how s/he decorates and maintains the office
or, especially, the home office environment, also commu-
nicate information to clients (Russell 2006; Zur 2007).
Postmodernist and critical perspectives layer even more
uncertainty on any clean categorization of ‘‘self-disclo-
sure’’ by fragmenting a unified ‘‘Self’’ and a unified
‘Other’ along the fault-lines of subject position and power
(e.g. Butler 1999 [1990]; Foucault 1990 [1978]). Critical
social work theories and postmodern perspectives presup-
pose that knowledge is constructed and defined by where
an individual is located in terms of socially-relevant cate-
gories such as race, religion, gender, and so forth (e.g.
Heron 2005; Keenan 2004). Thus, the knowledge that is
accessible by either therapist or client would be multiply
determined by existing power structures and relationships.
For example, a racialized client may see self-disclosure in a
question by a white/non-racialized therapist which the
therapist viewed as non-disclosing, since the client may
recognize in the question an assumption about how the
world works which does not apply to his/her own reality.
Does such an exchange qualify as TSD?
For most of the theorists and researchers discussed in
this paper, ‘‘TSD’’ is defined as intentional, verbal reve-
lation of the therapist’s life outside of work, therefore
excluding the realm of ‘‘professional’’ disclosure such as
professional training, theoretical orientation, professional
experience with particular populations or issues, or office
policies about availability or vacation times and the like
(Zur et al. 2009). Knox and Hill (2003) defined seven types
of therapist disclosure: disclosure of fact, feeling, insight,
strategy, reassurance or support, challenge, and immedi-
acy. These categories are all grounded in and communi-
cated through verbal revelations of the therapist’s
experience, past and/or present. However a simple and
precise definition of the term ‘‘TSD’’ is elusive, and the
possibility that different people might know, reveal, or see
different information about the therapist complicates
research design, interpretation of findings, development of
theory, and implications for practice.
Research on Therapist Self-Disclosure
Overall Challenges
In researching TSD, the definitional challenge continues
throughout the process of determining whom to ask and
what to measure about TSD. As previously discussed,
clients and therapists can be expected to have different
understandings of what has been revealed about the ther-
apist, by the therapist. Indeed, research shows that thera-
pists are less consistent in their ratings of the helpfulness of
TSD than clients are (Roberts 2005; Knox and Hill 2003).
Non-clients (research participants rating videos or tran-
scripts of therapeutic interactions) tend to rate therapists
who use TSD more highly than those who do not, however
it is difficult to know whether such third-party ratings
reflect clients’ experiences (Hill and Knox 2001). A further
challenge in research is posed by the measurement of
outcomes, in going beyond defining TSD and calculating
its frequency to evaluating its effects (Henretty and Levitt
2010; Knox and Hill 2003).
It is difficult to standardize anything about therapy and,
by self-disclosure’s very nature, it is almost impossible to
standardize TSD. TSD is different for each therapist, since
each therapist, as an individual, has a unique constellation
of possible disclosures. The impact and perception of this
constellation of possible disclosures will also change with
each client. Thus, in order to obtain a complete overall
picture of TSD practices and their effects, researchers are
compelled to rely on a range of techniques and sources and
then triangulate their findings (Roberts 2005; Knox and
Hill 2003).
Researchers have indeed used many different approa-
ches to study TSD and its effects. Some have used stan-
dardized videos of sample client-therapist sessions with
varying amounts of TSD and asked individuals who watch
these videos to rate their impressions of the therapists’
competence (e.g. Myers and Hayes 2006). Others have
used narrative or conversational analysis techniques to
examine the interactional process of TSD (Leudar et al.
2006). Some have used experimental designs, providing
some sessions using TSD, and others without, and asking
clients to rate the effectiveness of the session (Henretty and
Levitt 2010). Others are retrospective, asking clients about
their recent or previous experiences with TSD, and
inquiring about their impressions of this self-disclosure and
its impact on the therapeutic process (e.g. Lokken and
Twohey 2004).
The majority of research on TSD, however, relies on
therapist self-report. Some studies use reports from a
sample of therapists (e.g. Burkard et al. 2006). However,
the case study is one of the most common ways to present
therapists’ perspectives on their own use of self-disclosure
Clin Soc Work J (2012) 40:287–296 289
(e.g. Denney et al. 2008, most of the entries in the col-
lection by Bloomgarden and Mennuti 2009a; Guthrie 2006;
Cole 2006; Roberts 2005). One of the strengths of the case
study is its focus on the decision-making processes that
surround TSD. Case studies also provide opportunities for
therapists to consider how this decision-making engages
the therapist’s own needs and interests, a useful counter-
balance to the written guidelines and theoretical models
which usually limit their analyses to client needs and
A number of therapists have, in this context, talked
about how the ‘‘traditional’’ boundaries which prohibit
TSD often provide the ‘‘easier’’ option for the therapist, but
at an apparent cost to the client and to the therapeutic rela-
tionship (e.g. Bloomgarden and Mennuti 2009b; Rabinor
2009). Some authors even reveal their own experiences of
TSD from both sides, as a therapist and as a client (e.g. Prenn
2009). However, the obvious limitation of the case study
approach is that it relies on a single perspective, and on the
willingness and ability of the author to examine ‘‘positive’
and ‘‘negative’’ TSD motivations and outcomes.
Research Findings on Therapist Self-Disclosure
Almost all therapists report that they disclose some infor-
mation about themselves to clients, at least some of the
time, with no consistent differences by gender (Henretty
and Levitt 2010). Overall, therapists report that they use
self-disclosure sparingly, ranking it as one of the least fre-
quently employed techniques (Maroda 2009; Farber 2006).
Several factors have been found to affect the frequency
of TSD. TSD does seem to be correlated with theoretical
orientation: psychodynamically-oriented therapists gener-
ally disclose less frequently than humanistic or feminist
therapists (Henretty and Levitt 2010). Therapists generally
disclose less about themselves to clients whom they per-
ceive to be more symptomatic or less stable (Kelly and
Rodriguez 2007). In certain practice settings, such as
substance use treatment programs or feminist therapy
practices, therapists are more likely to disclose (Nerenberg
2009; Sparks 2009). In terms of the different professionals
who work as therapists, there are indications that profes-
sional experience and training influence their likelihood to
disclose to their clients. New therapists seem to disclose
less frequently, in general, than more experienced thera-
pists (Henretty and Levitt 2010). Clinical social workers
report moderately less support for the effectiveness of TSD
than those trained as Marriage and Family Therapists
(MFTs) (Jeffrey and Austin 2007). However, insufficient
attention has been paid to how professional training and
affiliation affect rates of TSD: such questions warrant
further investigation.
Therapist self-disclosure seems to have differential
effects based on the quality of the relationship and type of
disclosure. Henretty and Leavitt’s review of TSD studies
(2010) concluded that the quality of the alliance affects
how clients perceive TSD, with stronger alliances leading
clients to rate therapists that disclose as more attractive,
likeable and warmer. However, in the absence of a strong
alliance, TSD can show negative effects on clients. These
same researchers found mixed results regarding the effects
of different types of TSD, however some evidence suggests
that the ‘‘self-involving’’ type of disclosure (thoughts and
feelings about the clients) elicits more positive responses
than ‘‘self-disclosing’’ types (accounts from the therapist’s
experience outside the therapeutic interaction) (Henretty
and Levitt 2010). Similarly, Myers and Hayes (2006) found
that third-party observers of a single taped session rated
‘general disclosure’’ (less intimate connections between
the therapist’s experience and the client’s) higher than
either no disclosure or ‘‘countertransference disclosure’
(more intimate connections between the therapist’s expe-
rience and the client’s), but only when the alliance was
strong. Knox and Hill (2003) also concluded that ‘‘disclo-
sures of immediacy,’’ those which highlight the therapist’s
feelings and thoughts in the present moment of the therapy
interaction, are most valuable to the client.
Therapist Self-Disclosure and the Stages of Change
Therapist self-disclosure changes across different points in
time in the therapeutic relationship. Many therapists report
that they disclose biographical information to new clients,
such as their professional training, previous experience,
and some demographic information (e.g. parental status)
(Henretty and Levitt 2010; Knox and Hill 2003). Therapists
also report that they use self-disclosure, often of the ther-
apist’s emotional and immediate experiences, as a means to
overcome an impasse or a rupture in the alliance (e.g.
Sparks 2009; Roberts 2005; Rabinor 2009).
Toward the end of a therapeutic relationship, there may
also be an increase in TSD (Henretty and Levitt 2010). As
described by Gelso and Carter (1994), the client’s response
to information about the therapist changes over the course
of the relationship, so that clients at the end of a therapeutic
process usually have higher levels of interest in and tol-
erance for information about their therapist as a ‘‘real’
person. Knox and Hill concur with this view: ‘‘Therapist
self-disclosures at termination may be particularly effec-
tive, and therefore we also encourage therapists to consider
using this intervention as therapy ends’’ (2003, p. 537).
These authors cite research findings that such disclosures at
termination may help make the therapist ‘‘more real and
more human’’ to the client.
290 Clin Soc Work J (2012) 40:287–296
The Socio-cultural Context of Therapist
There are inconclusive findings about the impact of gender
on client responses to TSD (Henretty and Levitt 2010). Other
client variables have also shown limited significance in terms
of the frequency of TSD. While there may be an assumption
that therapists working with children might disclose more
frequently, one investigation shows only minimal differ-
ences in the frequency of TSD between therapists of adult
and child clients (Copobianco and Farber 2005). This same
study found that child clients may be more likely to ask for
certain types of disclosure, such as parental status and hob-
bies, and that total non-disclosure from the therapist could
pose a particular threat to the therapeutic relationship.
Findings from studies on particular ethnoracial groups
and TSD suggest that the impact of TSD may change
across cultural contexts. For example, Lokken and Twohey
found that American Indian clients rated their European
American counsellors higher when the therapists self-dis-
closed (2004). A study of European American therapists
who reported on their use of self-disclosure in cross-cul-
tural counselling found that most of these therapists used
TSD to join with clients and felt that this was an effective
intervention (Burkard et al. 2006). Other researchers have
found that clients from a Mexican background may prefer
non-disclosing therapists, while African-American clients
may prefer therapists who use TSD (Henretty and Levitt
2010). More research is needed, particularly regarding TSD
and cross-cultural work outside of American national
contexts. Also, little research has been done on a complete
range of therapists’ own ethnoracial identities and their
self-disclosure to clients (Roberts 2005).
Illness, disability, and physical transformations such as
pregnancy are frequent topics of concern in the literature
on TSD. In some cases, not appearing/being pregnant can
also necessitate disclosure, as when I needed to alert clients
to an upcoming departure when my partner would be
giving birth to our daughter. This disclosure also necessi-
tated ‘‘coming out’’ to some clients to whom I had not
previously disclosed my sexual orientation. Often, in as in
my own situation, self-disclosure is not entirely voluntary,
since the client may have already discerned the situation
from the therapist’s appearance or unavailability. However
the therapist may still choose how, when, and how much
s/he communicates about his/her experience, and this
process may prove beneficial to the therapeutic work.
For example, Gilbert Cole (2006) recounted his expe-
rience as an HIV-positive psychoanalyst who had been
trained not to disclose information to clients. While self-
disclosure had become a matter of course in his practice
with HIV-positive clients, he described his uncertainty
about the possible impact of disclosure with HIV-negative
clients, raising the question: Is TSD most helpful when it
reveals similarity between therapist and client? Are there
instances when disclosure of difference between therapist
and client, even significant difference, can be powerful and
beneficial? Most of the current writing on TSD does pre-
suppose that it will be used to highlight similarity rather
than difference between the therapist and the client, how-
ever this assumption may be ill-founded.
Other illnesses and disabilities may be more visible and
therefore more subject to direct questioning by clients. For
example, Dan Gottlieb recounted how bodily realities of his
quadriplegia were used as part of the therapeutic process with
clients (Gottlieb et al. 2009). In general, he disclosed fre-
quently in his practice, and he described several cases where
clients nurtured him as part of the therapeutic relationship
(e.g. comforting him after learning of a death in his family, or
after seeing that his catheter had leaked). Of course, regard-
less of the existence of physical ailments, the practice model a
therapist uses will have an impact. Gottlieb’s understanding
of the therapeutic process prioritized genuineness and
mutuality, whereas Cole’s practice theory viewed any care-
taking of the therapist by the client as a serious complication.
One area of cultural diversity which has inspired espe-
cially extensive research and theory on TSD has been in
work by or with lesbian/gay/bisexual/trans/queer (LGBTQ)
people (Cole and Drescher 2006). Issues surrounding dis-
closure are central in the lives of many LGBTQ people.
Decisions about ‘‘coming out’’ (disclosing one’s sexual/
gender identity) permeate LGBTQ life. A number of writers
have concluded that therapists working with LGBTQ clients
and communities should be prepared to disclose informa-
tion about their own sexual/gender identities and their
professional experience with LGBTQ communities (Hen-
retty and Levitt 2010; Cole and Drescher 2006; Russell
2006; Guthrie 2006). As part of a community which is both
deeply stigmatized and often invisible to outsiders, LGBTQ
clients frequently seek out therapists who either belong to or
have good reputations in LGBTQ communities. At the same
time, ‘‘sexual’’ disclosures, including the therapist’s sexual
orientation, are rated as among the least common disclo-
sures by therapists (e.g. Jeffrey and Austin 2007) and other
authors on TSD, such as Hill and Knox, have concluded that
‘the least appropriate topics [for TSD] include sexual
practices and beliefs’’ (2001, p. 416).
Here we see how the context of the therapeutic inter-
action will influence the definition of what TSD is
‘appropriate’’. For example, the setting where I was asked
to disclose my sexual orientation as a matter of policy was
a substance use treatment program for LGBTQ people.
There, practitioners operated from a feminist, anti-oppres-
sive perspective and promoted clients’ involvement in
LGBTQ communities as a strategy to support positive
change. Therapists’ routine disclosure of their sexual
Clin Soc Work J (2012) 40:287–296 291
orientations was therefore consistent with the setting and
theoretical grounding of the program, with sexual orien-
tation seen as a ‘‘professional qualification’’ rather than a
‘personal revelation’’.
On the other hand, there was no clear policy on ‘‘sexual
orientation’’ as a topic of self-disclosure at a family mental
health program where I worked. There, I came out as a lesbian
to one of my clients after he talked about planning to ‘bash’
gays—this was thus a strategic disclosure of ‘‘difference’
(Cole 2006). My client’s parents were upset at my decision and
spoke with other members of the team. My supervisor then
suggested, in my formal review, that I should have consulted
with the parents before coming out to the son, and asked that I
follow the parents’ demand and not discuss the topic further
with the young man. In that work setting, and for those col-
leagues and parents, my self-disclosure was deemed ‘‘inap-
propriate’’. However, I believe that this self-disclosure
resulted in useful reflection for the client in question, and
possibly influenced his future behavior; furthermore, this
disclosure ultimately seemed to strengthen our relationship,
even as it challenged the young man’simmediate assumptions.
There is also an equity concern for therapists and clients
in the valuation of what TSD is deemed ‘‘too much’’: for
example, in a heteronormative society, my family and
relationships are seen as more ‘‘sexual’’, and hence more
‘personal’’, than those of most heterosexual therapists. If I
mention my partner’s gender, as in a reference to ‘‘my
wife’’, this communication is generally viewed as a greater
degree of self-disclosure than a similar reference to a
‘husband’’ would be. This is not only an LGBTQ concern;
other ‘‘minority’’ identities and affiliations can carry similar
presumptions of intimacy. The setting of clinical practice is
thus much larger than institutional affiliations, and
encompasses societal understandings of intimacy, profes-
sionalism, and normalcy/health. Furthermore, as Martha
Sweezy (2005) has pointed out, many risks of TSD are
assumed by the therapist, and, given the unidirectionality of
confidentiality policies, these can extend far beyond the
therapy room. Clients are free to pass on any information
that they receive from their therapists, and thus therapists
must evaluate the possible ramifications of their revelations
being disclosed to anyone and everyone. What therapists
have at stake in any particular disclosure is thus greatly
dependent on the larger socio-cultural context of the inter-
action, as well as the institutional setting, therapeutic rela-
tionship, and the therapist’s own emotional landscape.
Theories, Common Factors, and Mandated Limits
to Therapist Self-Disclosure
Research, theory, and practice all suggest that the use and
understanding of TSD is one of the most divergent topics
across the main theoretical traditions (Zur 2007). At the
same time, all theoretical traditions have diverse mem-
berships and iterations, thus the following summaries
describe general trends only. Furthermore, shifts and
developments in all practice theories have been influenced
by broader cultural changes which have encouraged and
normalized much greater levels of self-disclosure in wes-
tern cultures over recent decades.
Following Freud, a number of psychoanalysts ques-
tioned and challenged the goals of neutrality and non-
disclosure, Ferenczi the most prominent among them;
however the central tenets of classical psychoanalysis
remained unchanged (Farber 2006). With the rise of the
contemporary psychodynamic schools, the therapist-client
relationship, ‘‘real’’ as well as ‘‘transferential’’, became a
central element of practice. An increased flexibility was
introduced which allowed greater transparency and dis-
closure between therapist and client. However psychody-
namic therapists have continued to be more conservative in
their use of TSD than other practitioners (Henretty and
Levitt 2010).
In recent decades, a general shift has elevated the status
of the therapeutic relationship/alliance across all major
theoretical traditions. As Barry Farber (2006) has observed,
much of this shift was presaged by Carl Rogers’ work in
the mid-twentieth century, however Rogers has received
little recognition from the authors who have since advo-
cated for a deeper appreciation of the ‘‘real’’ therapist-
client relationship. Humanistic theories, starting with Carl
Rogers’s client-centered model, have emphasized genuine
connection and empathic understanding at the foundation
of the healing relationship, and have therefore endorsed
some use of TSD, as long as it serves this connection and
the client’s well-being.
Cognitive-behavioral theory (CBT) began with a stated
disregard for therapeutic relationship, but CBT practitioners,
including founding theorists, have frequently used ‘‘model-
ing’’, ‘‘reinforcement’’, and ‘‘normalizing’’ as effective CBT
techniques (Farber 2006;Zur2007). TSD is often an
essential component of each of these techniques. In more
recent variants of CBT, such as dialectical-behavioral ther-
apy, disclosures of the therapist’s thoughts and feelings
about the patient are commonly introduced into the therapy,
in quite tightly prescribed ways (e.g. Filetti and Mattei 2009).
Family therapy theories vary widely and thus there is no
single ‘‘stance’’ toward TSD (Roberts 2005). Some early
schools of family therapy, such as structural and strategic
approaches, maintained an ideal of therapist non-disclo-
sure, with occasional exceptions to facilitate ‘‘joining’
with clients. Symbolic and experiential approaches, on the
other hand, used TSD liberally. Bowenian theory, while
initially circumspect regarding TSD, moved to a more
flexible and open position. Other, more recent approaches,
292 Clin Soc Work J (2012) 40:287–296
such as narrative, reflecting team, and feminist theories,
promoted new goals of ‘‘transparency’’ and ‘‘collabora-
tion’’ with clients. As a result, practitioners of these newer
approaches disclose more frequently to clients. For
pan-theoretical guidelines to TSD in family therapy, see
Roberts (2005).
In work with groups, there have been different theoret-
ical and practical considerations in TSD. A number of
group therapists have talked about the potential for nega-
tive outcomes if therapists are unnecessarily evasive about
themselves, balanced against significant risks to both the
group and the therapist if disclosures are ill-conceived or
premature (e.g. Weiner 1983; Bloomgarden and Mennuti
2009b; Barber 2009). In general, group practices have been
more open to TSD, with the caveat that therapists need to
be prepared for the multitude of possible responses they
may receive from clients, necessitating continual manage-
ment of how the self-disclosure affects all group members
individually, and how it affects the interactions of the
group as a whole.
As one of several ‘‘critical’’ practice theories, feminist
theory has its origins in challenging central tenets of pre-
existing models. In terms of TSD, feminist theory has
consistently, from its inception, advocated the potential
benefits of TSD, and the potential harms of the strict pol-
icies of non-disclosure found in early/traditional approa-
ches (Sparks 2009). Feminist theory advocates a critical
examination of the use of power in the therapeutic rela-
tionship, and a re-examination of how this relationship can
become more equitable and collaborative.
For example, ethical guidelines from the Feminist
Therapy Institute (2000) state:
A feminist therapist discloses information to the cli-
ent which facilitates the therapeutic process, includ-
ing information communicated to others. The
therapist is responsible for using self-disclosure only
with purpose and discretion and in the interest of the
client.A feminist therapist educates her clients
regarding power relationships. She informs clients of
their rights as consumers of therapy, including pro-
cedures for resolving differences and filing griev-
ances. She clarifies power in its various forms as it
exists within other areas of her life, including pro-
fessional roles.
In this therapeutic model, TSD is not only permitted, it
is required as part of informing the client of the therapist’s
role and in working toward collaborative definitions of the
problems and strategies involved. At the same time, the
therapist has a clear responsibility to justify any TSD and
to address its impact on the client.
While the theoretical orientation of therapists demon-
strably affects their understanding and use of self-
disclosure, theory is not everything. Indeed, as in so many
other areas of clinical research, the current evidence shows
considerable commonality between the different theories
with regard to TSD (Henretty and Levitt 2010). The con-
cept of ‘‘common factors’’ is therefore useful with regard to
TSD, particularly as therapists strive to turn theory and
research into practice. ‘‘Common factors’’ are the elements
of the therapeutic intervention that cannot be explained or
limited by theoretical orientation. Comparative research on
the outcomes of different theoretical models has, for many
years, found that the ‘‘dodo bird verdict’’ applies: all have
won, and all shall have prizes, as declared by the dodo bird
in Lewis Carroll’s classic, Alice in Wonderland (Luborsky
et al. 2002). In their consideration of such findings, Messer
and Wampold (2002) suggested moving from research
comparing the relative efficacy of different theoretical
modalities, to considering what elements, common to all
psychotherapeutic theories, account for the bulk of positive
client outcomes. This shift in perspective has opened up a
wealth of possibilities for psychotherapeutic research;
variables which were once ‘‘confounders’’ in research
design have since become the subjects of investigation, in
their own right.
A central finding in this research into common factors
has been the singular importance of the therapeutic rela-
tionship and, in more recent conceptualizations, the thera-
peutic alliance (Messer and Wampold 2002). ‘‘Therapeutic
alliance’’ is a more precise and inherently collaborative
construct than ‘‘relationship’’, as ‘‘alliance’’ also incorpo-
rates consensus on tasks and goals of therapy. The thera-
peutic alliance has been found to be one of the most stable
predictors of therapeutic outcome (Horvath 2000).
As the range of theoretical perspectives has converged
in recognition of the therapeutic relationship, so have
practice guidelines on TSD. Using a pan-theoretical
framing, Knox and Hill (2003) developed guidelines for
therapists in using self-disclosure based on numerous
research studies with therapists from a variety of theoreti-
cal orientations, and on the responses from their clients
(Table 1). As a result, they can be viewed as ‘‘common
factors’’ or ‘‘best practices’’ of effective therapist self-dis-
closure. Even with the authors’ more complete descriptions
and examples for each guideline, the interpretations of
these suggestions depend very much on the subjective
judgment of the individual practitioner. As previously
discussed, what is deemed ‘‘appropriate’’ for one setting,
therapist, client or therapeutic moment, might be ‘‘inap-
propriate’’ in another. However, they provide an excellent
starting point for putting research into action, regardless of
the practitioner’s stated theoretical allegiances, and they
have been largely echoed by other authors on this topic
(e.g. Bloomgarden and Mennuti, 2009a; Farber 2006;
Roberts 2005; Maroda 2009).
Clin Soc Work J (2012) 40:287–296 293
Knox and Hill’s guidelines on TSD are also congruous
with the codes of ethics promoted by various professional
bodies which regulate psychotherapeutic practice. The
current guidelines stand in counterpoint to early iterations
of practice ethics which, while they officially prohibited
TSD, were not codified and thus permitted a wide range of
boundary crossings now deemed unethical (such as sexual
relationships with clients, ‘‘mutual analysis,’’ or therapeu-
tic work with the therapist’s own family members). The
professional codes have been altered in recent years to
recognize the increasing flexibility of therapeutic bound-
aries in terms of self-disclosure, while still upholding the
current legal and ethical sanctions against boundary-
crossings such as sexual contact with clients (Zur 2007).
Therapist decision-making is influenced by legal con-
siderations beyond the scope of the professional guidelines.
As Martin H. Williams (2009) has described, increasing
concerns about litigation have led malpractice insurance
providers to urge practitioners to veer away from all self-
disclosure, at least in the American context. While research
suggests that the overwhelming majority of practitioners
continue to use TSD, albeit infrequently, there is some
evidence that younger generations of therapists are dis-
closing less often, even as theory-based prohibitions
against such self-disclosure have loosened (Zur 2007). The
socio-legal context may be partially responsible for this
trend, although further investigation is required.
Therapist self-disclosure inspires both passionate convic-
tions and uncertain discomfort. While researchers have
created a healthy body of literature to support the validity
of TSD as a potentially valuable intervention, individual
practitioners continue to struggle with the question: What
should I reveal? As much as theory, research, and legal or
ethical codes can guide us, the ultimate decision and its
repercussions will be primarily confined to the people who
are in the therapy room.
Furthermore, some of the concerns about therapist
self-disclosure may quickly become dated in the era of
the Internet. Clients can now be expected to look up
information about therapists, or even potential therapists,
and have available to them an increasing array of often-
intrusive online investigation techniques (Zur et al.
2009). Non-disclosure may never have been a ‘‘real’’
option, but it is certainly a total impossibility in the age
of Google. Increasingly, therapists will not only need to
decide how much to disclose, but how much to guard
against disclosure. Already, therapists need to make more
technologically-informed decisions as they choose whe-
ther and how to engage with social networking, online
advertising, or even publication. What might once have
been unlikely to catch clients’ attention, such as journal
contribution or even a charitable donation, can now be
retrieved within a matter of seconds. Practitioners should
proceed from the assumption that their clients know far
more about them than they have ever intentionally dis-
closed, and that clients may then choose to broadcast
further information online. New conversations may be
required, and therapists may need to actively manage
their online profiles.
The Internet is certainly not the only large-scale societal
development to influence TSD. Some authors have sug-
gested that other traumatic, societal events such as mass
terrorism, natural disasters, or wars, might continue to alter
the bounds of what is considered appropriate. In particular
places and times, ‘‘shared trauma’’ alters both what clients
ask and therapists reveal, and non-disclosure can become
both impossible and undesirable (Tosone 2008,2011).
Decisions about self-disclosure are also unavoidable in
other professional relationships of therapists, such as the
instructor/student practitioner relationship (Pisani 2005).
As discussed by Rasmussen and Mishna (2008), when and
how the instructor discloses information about him/herself
is, in itself, instructive. Rasmussen and Mishna highlight
the potential value of instructor self-disclosure in promot-
ing student learning, but advocate a ‘‘fine balance’’
between revealing nothing and revealing too much (2008).
Table 1 Suggestions for using Therapist Self-Disclosure, from Knox and Hill (2003)
Use therapist self-disclosure because it is a helpful intervention, but use it infrequently and judiciously
Use appropriate content in therapist self-disclosures
Use appropriate levels of intimacy in therapist self-disclosures
Fit the disclosure to the particular client’s needs and preferences
Have appropriate reasons for self-disclosing
Return the focus to the client after therapist self-disclosure
Consider using disclosures of immediacy
Consider using disclosures to facilitate termination
Ask clients about their responses to therapist self-disclosure
Self-disclose about issues that you have mostly resolved, rather than those with which you continue to struggle
294 Clin Soc Work J (2012) 40:287–296
Indeed, throughout the literature on TSD, this metaphor
of ‘‘balance’’ recurs. Now that most practitioners,
researchers, and theorists are moving away from ‘‘Should
therapists disclose?’’ and toward ‘‘What, when, and how
should therapists disclose?’’ the risks and rewards of TSD
need to be weighed carefully, with the knowledge that the
scale may be imprecise and gravity unreliable. The human
endeavor of therapy finds much of its meaning in just such
heartfelt fallibility.
Acknowledgments This research was funded by a Joseph-Armand
Bombardier Canada Graduate Scholarship through the Social Sci-
ences and Humanities Research Council of Canada. The author would
like to acknowledge the insights offered on this topic by Dr. Faye
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Author Biography
Margaret F. Gibson is clinical social worker and a doctoral student
at the Factor-Inwentash Faculty of Social Work at the University of
Toronto. Her current research focuses on how service providers think
about and work with lesbian, gay, bisexual, transgender, and queer
296 Clin Soc Work J (2012) 40:287–296
... Theorists believe that disclosure can be extremely meaningful because it allows the patient to see the therapist as a real person-one who is more of a teammate than a coach (Farber, 2003). Self-disclosure can provide the client with the knowledge that their therapist has been through a similar experience, such as also being LGBTQ + (Gibson, 2012;Henretty & Levitt, 2010) or having also dealt with cancer (Lawson et al., 2021). From the humanistic tradition, it can function as a means of radical genuineness and unconditional positive regard (Gibson, 2012). ...
... Self-disclosure can provide the client with the knowledge that their therapist has been through a similar experience, such as also being LGBTQ + (Gibson, 2012;Henretty & Levitt, 2010) or having also dealt with cancer (Lawson et al., 2021). From the humanistic tradition, it can function as a means of radical genuineness and unconditional positive regard (Gibson, 2012). ...
... Research on the efficacy of therapist self-disclosure of health matters is sparse. More widely available are qualitative and theoretical examinations of this topic, which find that selfdisclosure of illness or other significant negative events in the therapist's life can have variable effects on patients (Gibson, 2012;Peterson, 2002). ...
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With the onset of the COVID-19 pandemic in 2019–2020 and the rapid development of vaccines to prevent this disease came a rise in interest around vaccine hesitancy. Naturally, methods of combatting vaccine hesitancy and increasing vaccination rates are of paramount importance. One such method is building upon the trust and openness of one’s relationship with their healthcare provider. Specifically, this paper examines how psychotherapist self-disclosure could facilitate effective health behaviors in patients, focusing on vaccines. Traditionally, mental health therapists have been encouraged to avoid self-disclosure of personal information due to the possibility of unbalancing or damaging the therapeutic relationship. However, research from medicine and other disciplines suggests that personal recommendation, self-disclosure of vaccination status, and expert encouragement may be effective methods of addressing vaccine hesitancy. In addition, recommendations for therapists in discussing vaccination and in working with vaccine-hesitant patients are provided.
... The supervisor and the supervisee must both accept the responsibility to create open and honest dialogue that will facilitate clinician growth and client success (Sweeney & Creaner, 2014); however, much of this burden falls to the supervisor (Bernard & Goodyear, 2014). More research is needed to continue investigating how supervisors may be able to facilitate the disclosure process for the highest quality of service offered to clients and the efficacious training of clinicians (Gibson, 2012). To date, clinical supervisory literature has indicated that the supervisory working alliance, supervisor's style of supervision, and the supervisee's level of counselor self-efficacy may be factors influential of supervisee self-disclosure to the supervisor (Ladany et al., 1996;Ladany et al., 2013;Mehr, Ladany, & Caskie, 2010;Sweeney & Creaner, 2014;Yourman & Farber, 1996). ...
... It can be difficult for supervisees to determine the information and concerns that are most influential and salient to the supervision process (Ladany & Friendlander, 1995;Mehr et al., 2010). Although self-disclosure is often part of a counseling relationship and the supervisory relationship (Gibson, 2012), it is the role of the supervisor to teach trainees about self-disclosure and model appropriate levels of self-disclosure (Knight, 2012(Knight, , 2014. Clinical supervision is a vital part of how clinicians learn what it looks like to appropriately engage in therapeutic use of self in their work with clients and how to create a safe, collaborative environment in which clients can grow (Armoutliev, 2013;Bernard & Goodyear, 2014;Knox, 2015). ...
The present study investigates how the supervisory working alliance, supervisor’s style, and the supervisee’s level of self-efficacy are able to predict the supervisee’s level of self-disclosure to the supervisor. Forty-two supervisees completed the Working Alliance Inventory – Trainee (Bahrick, 1990), Trainee Disclosure Scale (Walker, Ladany, & Pate-Carolan, 2007), Supervisory Style Inventory (Friedlander & Ward, 1984), and Counseling Activity Self-Efficacy Scales (Lent, Hill, & Hoffman, 2003). The supervisee’s level of self-disclosure was statistically significantly predicted by the supervisory working alliance, supervisor’s style, and the supervisee’s counseling self-efficacy. Counseling self-efficacy was found to be a statistically significant predictor of supervisee self-disclosure.
... In the field of social psychology, self-disclosure is defined as "any information about oneself" [18,31] in a broad sense. More specifically, self-disclosure is defined as "the verbal communication of personally relevant information, thoughts, and feelings to another" [32] and is often referred to as "willful disclosures that provide insights into personal thoughts and feelings" [33,34], including the actor's intentions. Studies of the role of self-disclosure in personality factors and individual differences have been conducted [19,[35][36][37][38]. ...
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... Although MHPle are not expected to share, fear of prejudice and discrimination, in the context of stigmatising attitudes held by colleagues (Carrara et al., 2019), is thought to contribute to a "culture of non-disclosure" (Boyd et al., 2016;Harris et al., 2016) that prevents them from doing so if they want to (Hogg & Kemp, 2020;King et al., 2020King et al., , 2021RANZCP, 2016;Victor et al., 2022). Social work researchers have highlighted how the lack of appropriate discipline-specific support (Kundra & Salzer, 2019) and fear of breaching professional standards (Gibson, 2012;Lovell et al., 2020) contributes to a reluctance to share with colleagues and supervisors. A scoping review conducted by the authors, of 23 studies that included MHPle participants, identified conflicting ways of thinking about lived experience that impact the value and inclusion of all staff with lived experience (King et al., 2020). ...
Over the past three decades, “lived experience” designated roles in mental health services in Australia have increased. However, the lived experience of staff in roles not designated in this way is often hidden or unacknowledged. This qualitative study included 33 participants employed in a range of roles at two Victorian mental health services, including 10 social workers. Interviews explored staff perspectives regarding the sharing of lived experience by staff with colleagues and supervisors. Concept analysis identified conflicting ways of thinking about lived experience, which influenced when and how staff shared and how they responded to sharing by other staff. These findings suggest the need to explicitly address the purpose and value of sharing lived experience in the mental health workplace, to better support staff and service users. Recommendations for social workers and their colleagues, working at all levels of the mental health system, are provided. • IMPLICATIONS • The perspectives and experiences of mental health service staff suggest room for improvement in the valuing and inclusion of staff with lived experience, which may have benefits for service-user experiences of support. • Promoting the value of sharing lived experience to reflective-practice and service reform is consistent with core social work values and, thus, the responsibility of all social workers, supervisors, and educators.
... 31). No entanto, neste texto, optamos por nomear como transparência duas formas através das quais o profissional se deixa ver nos atendimentos: o "tornar público", tal como proposto por Anderson (2018); e também o "compartilhar histórias pessoais', ação comumente descrita na literatura como autorrevelação, e que merece ser analisada em seus limites e potencialidades (Barnett, 2011;Gibson, 2012;. ...
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“Este livro é fruto de um precioso percurso de comprometimento e dedicação dos autores, que se envolveram na aventura de atenção às famílias no contexto de tratamento de pessoas com graves transtornos psiquiátricos. Um trabalho de fundamental relevância buscando responder às complexas necessidades, questionamentos e dificuldades próprias do desafio de qualificar a atenção psicossocial. O texto apresenta um diferenciado rigor metodológico e aprofundada fundamentação teórica, articulados por uma criativa capacidade reflexiva, diante das demandas que emergiram do trabalho clínico. Desta forma, se constitui como uma valiosa contribuição para o campo da assistência, do ensino e da pesquisa, iluminando com esperança e entusiasmo aqueles que se dedicam à construção de saberes e ao exercício do cuidado. Uma generosa oferta, que nos cabe acolher e agradecer”. Sergio Ishara Médico psiquiatra, mestre e doutor em Saúde Mental pela Faculdade de Medicina de Ribeirão Preto – USP. Coordenador Clínico do Hospital Dia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – USP. “Resultado de muitos anos de prática comprometida e pesquisa dedicada, esse livro explora como é possível promover uma ‘comunicação dialógica’ em contextos de saúde mental. A partir de vários exemplos e ilustrações de práticas situadas, Carla Guanaes-Lorenzi e Pedro Martins ensinam uma visão de comunicação que combina aspectos contextuais e responsivo-relacionais, mostrando como o diálogo não se reduz a uma relação imediata entre falantes, mas é atravessado por várias relações institucionais ao longo do tempo. Este é um livro empolgante que pode interessar a estudantes, pesquisadores, profissionais e todos aqueles que buscam democratizar e humanizar o cuidado em saúde mental” Emerson F. Rasera Professor Titular da Universidade Federal de Uberlândia (UFU), onde atua no Programa de Pós-graduação em Psicologia. Foi Presidente da Associação Brasileira de Psicologia Social. É Bolsista de Produtividade em Pesquisa (CNPQ).
... The 'textbook' position on revealing personal information is that it can be a potentially harmful and a potentially beneficial act (Wright 2021). This, however, depends on the context and modality in which the clinician is practising (Gibson 2012). For example, person-centred and cognitive behavioural therapies are often associated with greater openness towards revealing personal information as a way of modelling personal openness, normalising challenges and communicating coping strategies (Ziv-Beiman 2013). ...
Professional self-disclosure can be defined as the professional helper revealing by verbal means something personal about themselves to the person or persons they are seeking to help. This article provides reflections on child and adolescent mental health service (CAMHS) clinicians’ navigation of professional self-disclosure during the COVID-19 pandemic, focusing on self-disclosure in helping relationships with foster carers. Drawing on the authors’ experiences practicing and supporting clinical staff in specialist CAMHS settings, the article considers changes in the way the act of self-disclosure has been approached following the rapid shift to remote care delivery and changed communal social experience. Implications for mental health nurses working with foster carers are set out. It is suggested that there is increased scope for inappropriate uses of self-disclosure in the absence of conversations within an organisation about ethical professional practice.
... Despite being a central feature of peer support relationships (Gidugu et al., 2015), the explicit sharing of lived experience can be a contentious issue in mainstream mental health settings (Gibson, 2012). Our findings suggest the role of the YPW was more impactful when they shared openly about their lived experience, in response to topics being discussed in the group, and young people's experiences and questions. ...
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Aim: Groups facilitated by peer workers have been shown to be effective in improving recovery-related outcomes in adult populations. However, limited research has explored the involvement of peer workers in groups in youth mental health services. This qualitative study aimed to explore young people's experiences of participating in groups co-facilitated by youth peer workers and clinicians. Methods: Semi-structured interviews were conducted with 13 young people aged 15-25 years who had attended groups conducted in-person and online at a tertiary youth mental health service. Young people were receiving individual support through the service for a range of mental health concerns. Groups were conducted by two clinicians and a youth peer worker who had used the same service and had undergone training in Intentional Peer Support®. An inductive approach using open, process, in vivo and pattern coding was used to identify key themes. Concept mapping was used to explore the relationships between them. Results: Nine overarching themes were identified that highlighted the unique and complementary contributions of youth peer worker and clinician roles. The sharing of lived experience by youth peer workers facilitated young people's engagement in group discussions, hope for the future, and sense of belonging, whereas clinical input created a sense of safety, structure and purpose. Conclusions: These findings support the value of a co-facilitation model in improving the engagement and recovery outcomes for young people experiencing mental health challenges.
Today, practitioners of contemporary psychedelic medicine are faced with a unique challenge: supporting clients in integrating transpersonal and mystical experiences within a paradigm based on a materialistic, reductionist, and dualistic understanding of reality. Operating on assumptions of pathology and problem-solving, the Western medical model often lacks the theoretical basis to make sense of and integrate the full potentiality of psychedelic medicine. Nondualism can offer an alternative guide to engaging with and transmuting the beliefs and traumas that lie at the root of paradigms based on assumptions of separation. These frames can be deeply resourcing for both psychedelic guide and client. This article explores the challenges and limitations of the modern Western paradigm, as well as possibilities for how nondualism could be incorporated into future training of psychedelic guides.
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This paper describes the findings of interviews conducted with staff at two Australian mental health services exploring their perspectives and experiences in relation to the sharing of lived experience with colleagues and supervisors.
A variety of conceptualizations of the relationship between therapist and client, as well as the impact the quality of this relationship has on the client, are reviewed. Different hypotheses about bow the alliance might influence therapeutic progress are also presented. The review pays attention to both the historical and conceptual dimensions of this issue, and provides a summary of the empirical bases of the claims made of the value of a good alliance. The article concludes with a discussion of an integrated model of the alliance and a discussion of the clinical and training implications of our current understanding of this concept. © 1995 John Wiley & Sons, Inc. J Clin Psychol/In Session 56: 163–173, 2000.
The purpose of this article is to outline a series of recommendations to aid therapists in developing and integrating spiritual self-disclosure into the therapeutic process. The authors introduce six categories of spiritual self-disclosure by adapting Well's (1994) and Kottler's (2003) categories of self-disclosure. Arguments for and against therapist self-disclosure are offered, along with underlying assumptions inherent to the use of self-disclosures that incorporate spiritual themes. Assumptions and recommendations for therapists that may facilitate clinically relevant, culturally sensitive, and ethical implementation of spiritual selfdisclosure are offered. Case examples highlighting how therapists can integrate spiritual self-disclosures into clinical practice are also provided.
Luborsky et al.'s findings of a nonsignificant effect size between the outcome of different therapies reinforces earlier meta-analyses demonstrating equivalence of bonafide treatments. Such results cast doubt on the power of the medical model of psychotherapy, which posits specific treatment effects for patients with specific diagnoses. Furthermore, studies of other features of this model-such as component (dismantling) approaches, adherence to a manual, or theoretically relevant interaction effects-have shown little support for it. The preponderance of evidence points to the widespread operation of common factors such as therapist-client alliance, therapist allegiance to a theoretical orientation, and other therapist effects in determining treatment outcome. This commentary draws out the implications of these findings for psychotherapy research, practice, and policy.
This article applies concepts from critical social theories to shift the profession's discourse from the center-margin relations of generalist- multicultural practice to a model of socially located cross-cultural client-worker relationships. Critical theories examine patterns and meanings enacted within and between people in specific social locations at specific points in history that express particular relations of culture, power, and identity. This framework can help social workers listen, explore, conceptualize, and intervene in a more complex and effective manner. The article summarizes key themes in critical theories, redefines how social workers can use knowledge for practice, and concludes with discussion of a case illustration.