The Ethical use of Self- Disclosure in Psychotherapy - PowerPoint Presentation

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The Ethical use of Self- Disclosure in Psychotherapy - PPT Presentation

Professional readings and personal exploration Copyright Andrew R Tidrick LCSW 2014 Goals To be able to define selfdisclosure To be able to define different types of selfdisclosure To be able to identify situations associated with risk of inappropriate selfdisclosure ID: 567097

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Slide1
Slide2

The Ethical use of Self- Disclosure in Psychotherapy

Professional readings and personal exploration Slide3

Goals

To be able to define self-disclosure.

To be able to define different types of self-disclosure.

To be able to identify situations associated with risk of inappropriate self-disclosure.

To identify how the concept of “standard of care” applies to self-disclosure.

To encourage therapists to study and understand their life and history to engage more fully with clients.

To develop an understanding of the likely neurobiological implications related to self-disclosure.

To create your own framework for deciding what you will disclose, to whom and in what situations.Slide4

General rules

ALWAYS

self-disclose to help client

Analyze

yourself

, your

client

and your

setting/goal

of your work when deciding to self-disclose

Be especially cautious (maybe never!) about disclosing

sexual feelings

and

immediate personal problems

Be aware of all types of disclosure

Practice good self-care

Don’t be isolated in your work or lifeSlide5

Self-Disclosure Worksheet

Therapist factors

Client factors

Setting factors

Subject/content factorsSlide6

Definition of self-disclosure

From Bloomgarden and Menuti, a working definition of therapist self-disclosure we can use is: “

anything that is revealed about a therapist verbally, nonverbally, on purpose, by accident, wittingly, or unwittingly, inclusive of information discovered about them from another source

.”pg. 8Slide7

Why self-disclose?

#1-Build rapport, make connection

Sharing with your client some of your “data”, your background, may help to client connect with you

Develop alliance

Clarify similarities and differences

Avoid assumptionsSlide8

Why self-disclose?

#2-Dyadic regulation

Dan Siegel discusses the potential impact of empathy with client, “

Being empathic with patients may be more than just something that helps them “feel better” – it may create a new state of neural activation with a coherence in the moment that improves the capacity for self-regulation

.” (Siegel, 2006)Slide9

Why self-disclose?

#3-Therapist self-care

In his book, “The Transparent Self”, Sidney Jourard states, “

Yet, the hypothesis of the book is to the effect that, while simple honesty with others (and thus to oneself) may produce scars, it is likely to be an effective preventive of both mental illness and certain kinds of physical sickness

.” (Jourard, 1971)Slide10

What might be the connection between empathy and self-disclosure?

Self-disclosure of at least a therapist’s

authentic emotional reactions

to clients’ experiences is likely a significant portion of effective empathic responses to clients.

Perhaps a therapist’s authentic emotional responses are sufficient and self-disclosure of data and personal history is not necessary.Slide11

Why not self-disclose?

#1-You will lose control

With regard to the taboo against therapist self-disclosure, Bloomgarden and Menuti note that there are two primary sources of this taboo:

Fear of the slippery slope-that once a therapist self-discloses

he or she will lose control and eventually have a sexual relationship with the client

. As quoted in their chapter, Zur, 2000 states, “To assert that boundary crossings [such as self-disclosure] are likely to lead to harm and sex because they statistically precede them is like saying that doctor’s visits cause death because most people see a doctor before they die.”Slide12

Why not self-disclose?

#2-Be Freudian

Obedience to Freud

-- Essentially Freudian psychoanalytic training and tradition, which continues to be a part of many curricula for mental health professional educational programs, stipulates that self-disclosure is not a Freudian tenet. As Bloomgarden and Menuti quote from Freud, “

like a mirror, reflect nothing but what is shown

.” (Freud, 1912/1963, pg. 124Slide13

Why not self-disclose?

#3-It is self-serving

Providing effective service to clients is the priority and the standard of care.

Types of self-disclosure

Ofer Zur discusses various types of self-disclosure in his chapter, “Standard of care, ethical considerations.”

Deliberate Self-Disclosure

Verbal deliberate self-disclosure

Nonverbal deliberate self-disclosure

Deliberate Online (internet) self-disclosureSlide15

Types of self-disclosure

Nondeliberate and unavoidable self-disclosure

Unavoidable “everyday life” self-disclosure

Everyday, common self-disclosure

Nondeliberate nonverbal

Unavoidable announcement

Settings that induce unavoidable or “forced” self-disclosure

Accidental self-disclosureSlide16

Types of self-disclosure

Common investigative searches initiated by clients

Gathering information in the community

Stalking

Online searches by clients about their therapists

Reviewing professional Web sites and online resumes of therapists

Conducting a simple internet search

Joining social networks

Paying for specialized online background checks

Reading therapist’s postings on professional Listservs and in chat roomsSlide17

Types of self-disclosure

Zur notes that

all forms of deliberate self-disclosure are either

self-revealing

-giving information or data but not opinions, reactions, etc. or

self-involving

-personal reactions to situations, events, etc.

Slide18

“The Parade of Red Flags”

“The Parade of Red Flags” to follow is a simple list, without all of the specific examples included in the book for each “Red Flag”, which can help you to assess if you feel that you have crossed or come close to crossing an ethical boundary in your work. Slide19

“Red Flags” cont’d

“The Parade of Red Flags” from Patricia Keith-Spiegel

A Desire For A Different Relationship From Client/Psychotherapist

Rationalizing The Acceptability Of A Contemplated Boundary Crossing Or Deviation From Standard Practice

Concerns about Personal Ambition and Financial Gain

Needs for Enhancing One’s Own Self-Esteem

Expecting the Client to Fulfill your Personal or Social NeedsSlide20

“Red Flags” cont’d

Fear of being Rejected or Client Terminating Therapy for Financial or Other Reasons

Negative Feelings Towards a Client

Signs that the Client is the More Powerful Individual in the Relationship.

Personal Life Contaminating Professional Performance

General Red FlagsSlide21

Pros and cons of shared experiences with clients

How do you think having walked in your clients’ shoes, so to speak, strengthens or weakens your empathy and the quality of care you provide?

Clients may feel comforted when they “see” that you know what they are talking about

Therapist may assume they know what or how clients “should” feel based upon their own experiences which may give subtle message to clients to edit or change what they would have expressed naturally without the therapist’s self-disclosureSlide22

Standard of Care #2

What a Standard of Care is

Not

A standard of perfection

A black and white standard

Guided by risk management principles: Clinical application of self-disclosure versus defensive medicine guidelines

Following a particular therapeutic modality

Determined by outcome: Differentiating clinical intention from impact (Ofer Zur, 2009 in Bloomgarden and Mennuti)Slide23

The Big 2 for non-disclosure

In the book edited by Andrea Bloomgarden and Rosemary B. Menuti , in one chapter author, Karen J. Maroda, concludes that there are two types of therapist self-disclosure that “appears to be rarely, if ever, therapeutic: the disclosure of

immediate personal problems

, and the disclosure of

erotic counter transference

.” Pg 27.Slide24

Strategies to avoid inappropriate self-disclosure

What do you do to guard against these types of self-disclosure?

Have your own therapist.

Get supervision

Have an intimate partner

Have friends

Select or deselect clients who are not suitable for you: either for your career or temporarily

Be sure to have your own support system upon which you can rely to get your needs met when you have an “immediate personal problem.”

Be proactive-if you know you are going to have a personal problem if you continue on your current path, work hard to address that issue before it blows up and begins to affect your work with your clientsSlide25

Consideration of family history

How does a therapist’s family history affect his/her work?

What if the therapist does not know all of his/her history?

Consider Siegel/Hartzell’s concept of “coherent narrative” and its significance in parent/child attachment.Slide26

Coherent narrative

“In

The Developing Mind

, a proposal is made that narratives that make sense of life emerge out of the blending of the left-mode drive to explain and the right-mode storage of autobiographical, social, and emotional information….When the left-mode drive to explain and the right-mode nonverbal and autobiographical processing are freely integrated, a

coherent narrative

emerges.” (Siegel & Hartzell, 2003)Slide27

Parents and therapists

Siegel relates studies of attachment between children and parents to the relationship between therapist and client and suggests that they share some of the same relationship dynamics particularly with regard to

resiliency

and

self-regulation

. (Siegel, 2006)Slide28

Mirror neurons, empathy and change

Siegel discusses mirror neurons, resonance, interpersonal integration and empathy as components of an effective therapeutic relationship (Siegel, 2006)

“

Being open to our own bodily states as therapists is a crucial step in establishing the interpersonal attunement and understanding that is at the heart of interpersonal integration

” (Siegel, 2006) Slide29

Empathy

Siegel continues to say, “

.” (Siegel, 2006)Slide30

“Triangles are forever”

“Triangles are forever—at least in families. Once the emotional circuitry of a triangle is in place, it usually outlives the people who participate in it. If one member of the triangle dies, another person usually replaces him. The actors come and go, but the play lives on through the generations” (Kerr, 1988)Slide31

“It takes X generations to make an alcoholic and X generations to cure one.

In the end, in my self-disclosure to many of my clients, my message is that it may be difficult to completely change family dynamics now or individual traits quickly but each generation can make progress with commitment, consciousness and work.Slide32

From “Buddhism and the Art of Psychotherapy” Hayao Kawai

“Two monks are on a trip. On the way they have to cross a river on foot. Whereupon a beautiful lady comes there and seems to be reluctant to step into the river. A monk immediately embraces her and crosses the river. After that the two monks separate from her, and the monks go on their way. The two walk for some time in silence. Suddenly one monk says to the other, “I have been kept thinking whether it is right or not that a Buddhist monk embrace a young woman, even though it is obviously helpful for her.” The other answers: “Yes, I embraced her but left her when we crossed the river. You, on the other hand, have been embracing her until now.”

(Kawai, 1996)Slide33

General rules

ALWAYS

self-disclose to help client

Analyze

yourself

, your

client

and your

setting/goal

of your work when deciding to self-disclose

Be especially cautious (maybe never!) about disclosing

sexual feelings

and

immediate personal problems

Be aware of all types of disclosure

Practice good self-care

Don’t be isolated in your work or lifeSlide34

Bibliography

Brown, Brene. (2012).

Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent and Lead,

London, England: Penguin Group

Hughes, Daniel A. “Psychological Treatment Through Relationship: Attachment and Intersubjectivity”, British Journal of Play Therapy, Vol 1, Number 3, 4-9, 2005

Jourard, Sidney M. (1971).

The Transparent Self

, New York, New York: Van Nostrand Reinhold Company

Kawai, Hayao. (1996).

Buddhism and the Art of Psychotherapy

, College Station, Texas: Texas A&M University Press

Keith-Spiegel, Patricia. (2014).

Red Flags in Psychotherapy: Stories of Ethics Complaints and Resolutions,

New York, New York: Routledge

Kerr, Michael E. “Chronic Anxiety and Defining a Self: An Introduction to Murray Bowen’s Theory of Human Emotional Functioning”, The Atlantic, September 1988

Lamagna, Jerry and Gleiser, Kari A. “Building a Secure Internal Attachment: An Intra-relational Approach to Ego Strengthening and Emotional Processing with Chronically Traumatized Clients”, Journal of Trauma and Dissociation, Vol 8(1), 25-52, 2007

Siegel, Daniel J. “Toward an Interpersonal Neurobiology of the Developing Mind: Attachment Relationships, “Mindsight,” and Neural Integration”, Infant Mental Health Journal, Vol 22(1-2), 67-94, 2001

Siegel, Daniel J. (2007).

The Mindful Brain

, New York, New York: Norton

Siegel, Daniel J. “An Interpersonal Neurobiology Approach to Psychotherapy: Awareness, Mirror Neurons, and Neural Plasticity in the Development of Well-Being”, Psychiatric Annals, 2006

Siegel, Daniel J and Hartzell, Mary. (2003).

Parenting from the Inside Out: How a Deeper Self-Understanding Can Help You Raise Children Who Thrive

, New York, New York: The Penguin Group