Sunday, September 25, 2011

I Can Relate

It seems to be a perennial point of controversy: How much of ourselves do we share as part of our work with clients?

In the "old days," therapists were taught to be "blank screens" - to be as personally neutral as possible, so that everything happening in the room would come out of the client's psyche and become fodder for analysis.

Somewhere along the way, however, someone (thankfully!) realized that, try as they might, therapists could never fully "neutralize" themselves. And anyway, trying to create this neutral (non)persona could be a real barrier to the therapeutic relationship and the client's engagement/progress.

We now know that it's important to be genuine - to be fully present in the work with our clients. Unfortunately, we also know that sometimes therapists go too far, and let their own needs and vulnerabilities supersede the client's. As a result, most of us find ourselves spending a lot of time in a vast expanse of gray area about what to share, and what to keep to ourselves.

Yalom divides the gray area into three categories of self-disclosure: how therapy works, the therapist's reactions in session, and details of the therapist's private life. He thinks the first category should always be shared (and I wouldn't actually classify it as self-disclosure), and that there are many times when both of the other categories are appropriate and helpful. However, the therapist should consider the possible clinical significance of the disclosure ahead of time.

I tend to divide self-disclosure based on who initiates it: is it a response to a client's question, or something I'm volunteering? I don't divide it like this because I think one kind is more or less appropriate than the other - I think both can be appropriate OR inappropriate, depending. Depending on what? I divide it this way because each category seems to depend on different things.

Questions from clients
Obviously, a major consideration in framing our response to direct questions is what meaning that question has for the client. Why are they asking (and are they really trying to ask something a little different)? For example, someone might ask if I have kids out of general curiosity, because they think I look young, or because they want to know if I can understand what they're going through. It's important for my response to get at the client's real concern. Why are they asking now? Is it a distraction (like the kid who asked me in group if I was a virgin!), a reaction to an empathic failure, a sign of increased vulnerability, or something else.... What reactions do the expect or hope for, and how do they react to my real answer? Based on the meaning the question and its timing have for the client, our response may influence the client's ability or willingness to be vulnerable or continue with the work of the session. I tend to think, however, that as long as we handle it carefully and don't completely miss an underlying meaning, any answer we offer can help move the work forward. (Others may very well disagree about that, though!)

Information We Volunteer
The first questions we have to answer for ourselves before volunteering personal information are similar - why do we want to share, why this information, with this client, and why now? The point in asking all of these questions is to be sure that we're sharing for the "right" reasons - i.e., for the benefit of the client, rather than to meet our own needs. It's important to know where our vulnerabilities lie - to know what information we may have an impulse to share for our own benefit, and what information may be too sensitive for us to share in this context (a good reason for therapists to have also received therapy). A rule of thumb I was taught is that the client should never feel like they have to take care of you.

This week, I faced decisions about how to respond to questions and whether to volunteer information about the loss of my good friend and colleague. In one case, a mutual client asked if I was ok - but I sensed that she was really asking whether I could handle her problems on top of my own. I told her I was alright - not exactly true for myself, but true in that I was able to set aside my own pain to be fully present with hers.

In another case, a client had an eerily similar experience - the sudden death of a close friend her age. I wanted to tell her that I could relate, that I was dealing with the same kind of loss...but I didn't. I'm still not sure whether she would have felt more confident in my ability to understand and empathize...or less confident in my ability to hold her emotions. I didn't want her to feel like she needed to think about my needs, and I wasn't at all sure I could talk about my own loss in a way that was soothing to her.

When have you been on the fence about sharing something? How did you decide? Have you ever chosen to share or not share, but later wished you made the other choice?

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