Can a therapist manipulate a client

Ethics in Psychotherapy: Self-Revelation - From Malpractice to Method

SCIENCE

For a long time it was considered a mistake when therapists talked about themselves during a session. However, it is now known that self-disclosure to the patient can have a positive effect on the course of therapy.

Telling a patient something personal has long been considered a malpractice. In traditional psychoanalysis in particular, the therapist's self-revelation was strictly rejected because it endangered the transference and draws attention to the therapist. Only humanistic schools of psychotherapy discovered their potential and saw them as an opportunity to consolidate the working alliance. These and other positive effects were later also used by other therapeutic schools, and even psychoanalysis no longer completely rules out self-disclosure.

Self-revelation is not taught in training
Although a rethink has begun, self-revelation is still rarely used. This is believed to be due to the fact that it has both advantages and disadvantages. In addition, psychotherapists hardly share and discuss knowledge and experiences with self-disclosure at congresses or on the basis of specialist articles, reports and books. There are also no recommendations on this in the professional regulations or on the part of the professional associations. Another reason could be that self-revelation is not taught during training and in further education. It is either not addressed at all or presented in a predominantly negative way, which makes it difficult to deal with it. Psychotherapists therefore have virtually no opportunity to gain experience with self-revelation as a therapeutic method right from the start, which means that they always remain insecure and fearful in this regard, that they forego an effective method and that they do not use intuitive, haphazard methods Self-disclosures make mistakes.

Psychologists Jennifer Henretty and Heidi Levitt from the University of Memphis / USA regret that there is so much uncertainty about self-disclosure, because in their opinion it is part of everyday therapeutic life. After all, psychotherapists reveal a lot about themselves simply through their appearance, their gestures and facial expressions and their treatment room. In addition, there are language and the way of speaking, feelings expressed non-verbally and unconsciously and many other signals that the patients perceive and interpret in order to get a picture of their counterpart.

According to surveys, psychotherapists are willing to provide information about therapeutic orientation, titles, professional qualifications and other professional competencies - mostly at first contact and on websites. But then opinions diverge. While some try not to divulge any further information, others have less inhibitions or concerns about it. For example, they make no secret of marital status, age, place of residence, origin, hobbies, leisure activities and sexual orientation. In the course of therapy, some therapists also mention their personal thoughts, feelings and experiences, possibly even as a former victim, and they talk about emotions that the therapy process and the patients trigger in them.

Telling personal stories can create trust
Numerous empirical studies show that self-disclosure on the part of the therapist is welcomed by most patients. You will find therapists who reveal something about themselves every now and then who are more sympathetic, more honest and more humane than their buttoned-up colleagues. They also feel better understood, “more normal” and less alone. They feel that the other person trusts them and then develop more trust in the therapist themselves, which benefits the working alliance. In addition, patients are more willing to provide information when the therapist is too.

But there are also patients who are suspicious, jealous or obsessively curious. They do everything in their power to learn as much as possible about the therapist. They often ask very personal questions and also use other opportunities, such as gossip or internet research, to satisfy their curiosity.

Occasionally, patients do not want more information about the therapist. They consider self-disclosure to be unprofessional and fear that the therapist will become the focus of the action. Some are also afraid of violating boundaries or believe that they will lose respect for the therapist if they know too much about their fears and weaknesses. Others do not want to be intrusive and are afraid of harassing the therapist if they ask for personal information. Still others tend to brood and take everything to heart; knowledge of the therapist's problems, feelings or experiences would therefore be an additional burden. In addition, personality structures and disorders, such as narcissism and egocentrism, can also contribute to the therapist's lack of interest in self-disclosure. "Since every patient is different, it is up to the therapist to determine which patient is self-revelatory and which is not," say Henretty and Levitt.

The effect of a revelation cannot always be calculated
Self-revelation is very powerful, presumably because it is used so rarely and therefore its effect does not wear off. In addition, it impresses itself particularly well on the patient; many patients know what the therapist has revealed about themselves long after treatment. In addition, self-disclosure is never free of risk, and its effects cannot always be calculated. For example, a therapist's message to a newly divorced patient that he is also divorced could be positively received by her. She feels understood and sees in the therapist a fellow sufferer, perhaps also a role model, because he has overcome the consequences of the divorce. However, she could also conclude from this that the therapist is too preoccupied with his own problems and is therefore less able to address them. Perhaps she is also interpreting it as a signal that he is now free and ready for a new relationship.

Self-disclosure is not beneficial in every patient
Despite possible misunderstandings, self-disclosure can be used in a controlled manner with appropriate preparation and thus increase the success of the therapy. The following procedures are recommended in relevant publications:

- Psychotherapists should take a quiet hour to clarify their own point of view regarding self-revelation. You should list advantages and disadvantages and collect good reasons to make a conscious decision for or against self-disclosure. Even if this decision cannot be made consistently in everyday life, it still provides a basis for therapeutic action and protects against unpleasant surprises that one prepares for oneself, for example through thoughtless self-disclosure. The reasons for using self-disclosure are often given: to demystify the therapy and to reduce the therapist-patient gap, to improve the working alliance and to promote the therapy process, to remove ambiguities and to achieve openness and honesty in the patient to offer a role model and to make the patient feel like they are not alone with their problems. Under no circumstances should self-disclosure be used to control, manipulate, attack, surprise or impress patients. In addition, self-disclosure is not self-therapy and should not be used by therapists to satisfy needs for discussion, affirmation, compassion, or affection. It should also be avoided if self-disclosure hinders the transference or interrupts the patient's storytelling, if the therapist is too much of a focus, if limits are exceeded or if the patient is burdened, disturbed or over-stimulated by self-disclosure.

- Self-revelation should only take place in relation to certain patients. Many therapists disclose information especially when they have a positive and trusting relationship with the patient and when they meet him every now and then in everyday life. On the other hand, self-disclosure is not recommended for patients with severe personality disorders and poor ego strength, when the bonds between therapist and patient are less tight or when a patient tends to be worried a lot and to get into the problems of others.

- The contents of self-disclosure can produce different effects. While information on education, marital status, thoughts and feelings about the patient and the therapeutic relationship is relatively harmless, it is not advisable to tell the patient about therapeutic errors and unsuccessful therapy. Your own problems, for example with addictions or mental disorders, should not necessarily be addressed, even if they have been successfully overcome and there are many parallels between therapist and patient. Otherwise, patients may believe that the therapist is not very successful and competent, or that they are exerting an adverse influence on them because they keep reminding them of difficult times. In addition, there could be a kind of competition between therapist and patient as to who was / is more severely affected or who can get the problem under control more quickly or better. Values ​​such as tolerance, openness or reliability should also be left out. There is a risk that - especially if there are discrepancies between the values ​​of the therapist and the patient - they will be discussed extensively, lead to tension and distract from the therapy goal. They should only be discussed if they are directly related to therapy. This also applies to all other personal information. They are to be selected with care and should only be disclosed if they can be of use to the patient and serve the progress of therapy.

- There is no best time for self-disclosure. As a rule, however, psychotherapists inform their patients at the start of therapy about their therapeutic orientation and qualifications, possibly also about ethnicity or marital status. Such information is primarily of an educational nature and does not burden the patient. Many therapists even see it as an ethical obligation to provide this information in order to enable the patient to give informed consent to therapy. In the further course of therapy, some therapists prefer less and more impersonal, while others prefer more and more personal self-revelations. This is up to you, because there is no magic formula. In any case, it is advisable to inform the patient in advance that self-disclosure is occasionally used as a therapeutic method. Reasons should also be given. This ensures that the patients are not surprised or shocked, but can adjust to self-revelations. At the end of a therapy it can also be useful for a therapist to express his thoughts and feelings towards the therapy and the end of the therapy. As experience shows, this makes it easier to say goodbye to each other.

Disclose personal information only on an irregular basis
The point in time for self-disclosure usually arises spontaneously and from the situation. It is recommended that you only disclose personal information on an irregular basis. Sometimes the patient asks about it too. Then therapists should weigh up the background to the question, for example, whether the patient packs a statement into a question, whether he tests the therapist or whether he gets reinsurance. When it is clear what the purpose of the question is, the answer should be tailored to it.

- The way in which information is disclosed depends on the needs and preferences of the patient and must therefore be adapted. For example, some patients want emotional statements, while others want to be informed more factually. Too little personal information makes the therapist appear aloof and distant, while too much and personal information can confuse or overwhelm patients. It can also happen that self-disclosure is interpreted as helplessness, egomania or an offer of friendship on the part of the therapist. Or that a therapist overshoots the mark and pouring out his heart, using the therapy session as a continuous monologue or converting it into a chat. Here it is important to find the right level. In general, it is advisable not to get too personal and intimate, as this does not go down well with most patients. It can also be helpful to take notes on each self-disclosure in order to keep track of the content and frequency and to be able to better estimate the effects that will be achieved with the method.

In principle, the words should be chosen wisely and carefully considered in the context of self-disclosure. The self-revelation should have to do with what concerns the patient. In addition, it should always be consistent with the therapeutic goals and principles. The therapist should always ask himself who self-revelation is primarily for, whether its reasons are appropriate, and whether it promotes the therapeutic process. It should also be considered whether there are other ways and means than self-disclosure to convey information. It should also not be forgotten that personal information can be used against you, for example in your private sphere or in court proceedings. Therefore, any planned self-disclosure should be examined to see if it could be catchy.

- The reactions of a patient to a self-disclosure cannot always be assessed. Therefore, therapists should imagine possible reactions before self-disclosure and then ask the patient how he has received them and what it does for him. The patient should also find out as soon as possible why a self-disclosure has taken place. In addition, care must be taken that after a self-disclosure the patient and not the therapist is the focus of the therapy, as an initially positive reaction of the patient could otherwise turn into a negative one. Obtaining feedback enables the therapist to check the effects of self-disclosure, to intercept negative reactions and to plan the further use of the method.
Dr. phil. Marion Sonnenmoser

Contact:
Jennifer Henretty, University of Memphis, Department of Psychology, 202 Psychology Building, Memphis, Tennessee, 38152-6400 (USA), email: [email protected]
Bloomgarden A, Mennuti R: Psychotherapist revealed: Therapists speak about self-disclosure in psychotherapy. New York: Routledge / Taylor & Francis Group 2009.
Farber B: Self-disclosure in psychotherapy. New York: Guilford Press 2006.
Henretty J, Levitt H: The role of therapist self-disclosure in psychotherapy. Clinical Psychology Review 2010; 30 (1): 63-77. MEDLINE
Knox S, Hill C: Therapist self-disclosure: Research-based suggestions for practitioners. Journal of Clinical Psychology 2003; 59 (5): 529-39. MEDLINE
1.Bloomgarden A, Mennuti R: Psychotherapist revealed: Therapists speak about self-disclosure in psychotherapy. New York: Routledge / Taylor & Francis Group 2009.
2.Farber B: Self-disclosure in psychotherapy. New York: Guilford Press 2006.
3.Henretty J, Levitt H: The role of therapist self-disclosure in psychotherapy. Clinical Psychology Review 2010; 30 (1): 63-77. MEDLINE
4.Knox S, Hill C: Therapist self-disclosure: Research-based suggestions for practitioners. Journal of Clinical Psychology 2003; 59 (5): 529-39. MEDLINE
Ethics in Psychotherapy: Self-Revelation - From Malpractice to Method

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