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Should therapists self-disclose?

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Dr. Richard Grossman:
Hi everybody,

Here's an article about Marsha Linehan, Ph.D., the well-known creator of Dialectic Behavior Therapy (DBT) which is used to treat Borderline Personality Disorder (BPD).  She recently disclosed her own personal struggles with Borderline Personality Disorder in a New York Times article (6/23/2011): "Expert on Mental Illness Reveals Her Own Fight" by Benedict Carey.

http://www.nytimes.com/2011/06/23/health/23lives.html?_r=2&scp=1&sq=Marsha%20Linehan&st=cse

The article raises the issue of self-disclosure by therapists to their patients.  A quote from the article:  

“So many people have begged me to come forward, and I just thought — well, I have to do this. I owe it to them. I cannot die a coward,” said Marsha M. Linehan, a psychologist at the University of Washington.

And here's a response by a New York psychiatrist, Maureen R. Goldman, M.D., in Clinical Psychiatry News (7/6/2011):  "Editorial: Thoughts on Self-Disclosure for Psychiatrists"

http://www.clinicalpsychiatrynews.com/views/commentaries/blogview40731/editorial-thoughts-on-self-disclosure-for-psychiatrists/36388f6a86.html

This is a topic I have thought a lot about over the years, and one that I have strong feelings about--which I'll share.

But, as usual, I'd like to hear your comments first...

Richard
 

Hopalong:
Hi Richard,
I didn't see the links so haven't read the articles.

My first gut response is "Yes." For me, simply knowing my therapist is a human being with life issues and feet of clay is comforting.
The old model of rigid boundaries may be important in some cases; for me, it was not helpful.

At times when I was so self-absorbed I couldn't have cared less whether my T was alive or dead or a propped-up rent-an-ear,
so desperate was I to vent...this wouldn't have been so important. I cared only about feeling safe and being heard.

But in later life, I've found it very reassuring to know a few facts that remind me that a therapist is a person too. In one instance,
the T-relationship got boundary-blurred, as much through my lack of boundaries as his own. It wound up dying an appropriate death
with no hard feelings and perhaps relief on both sides. When I gradually learned some things about the hardships of his childhood, I had explanations for things I'd wondered about. I recognize the mistakes he (and I) made, but do not blame him or myself. Compassion and gratitude are how I think back.

Currently, when I was anguishing over my daughter, my now-T let me know that he has a daughter with a severe eating disorder.
It helped me recognized that not only was he being professionally compassionate, but that as a human being, he happened
to truly understand what it's like to have a troubled child in jeopardy. I occasionally ask him how she's doing, and I let him
know I'm not digging for detail. We seem to have a comfortable mutual recognition that boundaries aren't going to dissolve.
But he'll tell me something like--she's in a hospital program. Or, she's home with us now. And, he also mentioned once that
he is Quaker, which for me was also a positive thing to know about him. My trust was stronger and has remained so.

Once, he mentioned a prior marriage. And he often references insights from his work with couples. Those facts too are very
comforting, because I'm divorced. With an earlier T (who turned out to be fundamentalist and had NOT disclosed
to me how much that affected his view of me...even to the point that he pressed me to marry quickly when I'd mentioned
my inner voice was telling me to wait--which turned out to be a disaster for me)...the lack of knowing much (or enough)
about who he was as a human being as well as as a professional and what his values were, both hamstrung the therapeutic
relationship and also wound up causing me considerable personal harm.

If I had a therapist who was bipolar and clearly taking responsibility for being in treatment or on Rx and was behaving effectively
I would be grateful to know this. Maybe not the first session, but the first or second. Again, it would encourage me to see a T
as a human being as well as healer. It would then be my choice to decide whether that issue of theirs was triggering or an obstacle
for me in some way. I would be appreciative of the disclosure. Nothing shame-based about it, just an important factoid, perhaps.

My D and I went to see a counselor who is paralysed and severely disabled and wheelchair-bound. She didn't have to disclose
verbally. But we knew this key thing about her life.

I don't know why a counselor with a condition that required a bite of protein every 30 minutes wouldn't say, I have XX, so you'll see
that I pause to eat something during our session. Or someone with a hearing problem wouldn't say, I need for you to sit
in that chair because I'm deaf in one ear. Or, I have macular degeneration so I need to keep the office quite dark. Or, I am bipolar
and in treatment, it's well controlled, but I prefer to let clients know this in case that would be troubling for you. Etc.


Now, I view a careful and considerate amount of personal disclosure on the part of a therapist as a gift of respect to me.
I do understand that one would have to be very careful with how much to disclose, and when and how. I don't think there's
a blanket rule. But from my own experience, I am both encouraged and humbled by seeing those clay feet. It encourages me to take
fuller responsibility for my own healing, and discourages utter dependence on the therapist for learning about self, other, boundaries, etc.

Very interested in hearing your thoughts on this, and will look forward to the thread.

Thanks for posting this, Richard. (And I hope you and your wife are well...?)

best,
Hops

Dr. Richard Grossman:
Hi Hops,

Ooops!  Sorry.  I inserted the links...

Richard

sea storm:
Yes. Of course they should not keep self referring but sharing their experience helps the connection deepen.


Sea storm

Ales2:
These are all very interesting questions. I think the answer probably lies somewhere in the middle. What to disclose and when? When is it relevant? When would it be helpful and how would it help?  That said, disclosure as part of small talk about getting to know someone maybe not so much.

In my case, my T had written a book where he disclosures his issue with his mother in a small section of one chapter. This was helpful to me, because he said he was co-dependent and had to avoid getting over-enmeshed with needs of patients. Then later in T, he also told me that his own kids were in T, in response to his divorce. As I remember, I think it was relevant to my feeling that good parents turn out good kids who are not in T. He wanted me to feel less of the stigma of T when I was feeling very wounded.

I do think if I knew someone had a similar problem, as in "i know just how you feel", it can help one feel validated, heard and understood at the same time. 

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