How NOT to Handle Self-Disclosure (As Seen on TV)

The TV show "Go On," one of this year's new sit-coms on NBC, centers around a therapy group addressing issues of grief and loss. Of course, as a comedy, it shows a lot of what shouldn't happen, inside and outside group sessions. This week's episode (episode 105, in case you want to find it) provides an excellent illustration of how NOT to handle self-disclosure. 

It seems the group therapist has another job as a parking valet. One of the group members discovers this fact by following her (yes, every therapist's horror scenario). The one group member tells other members, who go to spy on her. Then they confront her about it during group. 

What an awkward scenario! I can only imagine most of us would be caught off guard, and may not respond as skillfully as we'd like. But, we can learn a thing or two from this fictional therapist's mistakes.

1) She responds defensively. 

The first thing out of her mouth (besides the requisite objection to group members following her!) is to clarify that she is not a "valet" but a "parking services manager." What does that communicate? From my perspective, it seems like she is insecure and trying to seem more competent in her clients' eyes...but only coming across as being embarrassed or having something to hide. 

A better response would have been to (a) acknowledge the fact that she has a job in a parking facility, and (b) turn the attention back to clients by exploring what it means to them that she has this job, and how they discovered it. For example, the client who initially followed her introduces the topic in group by saying "no more secrets!" There seems to be a lot underneath that statement.

2) She goes overboard trying to explain

The sense that she may be embarrassed by her job as a valet seems even more likely after she launches into a lengthy justification of how this menial second job is really a step toward career advancement because it is helping her go back to school and get a master's degree, because she loves her work with the group so much. 

While that may very well be true, from a client's perspective, I would not find it very reassuring. Her attempt to circle back to the group being her primary professional focus falls flat because it seems self-serving - a way to dodge the uncomfortable confrontation happening right now. Similarly, her attempt to spin the parking job as a means to professional development runs the risk of making clients either doubt her competence (if she has to go back to school to do what she's doing in group), or worry that she will leave them once she is done with school (a reasonable guess). 

As with most cases of self-disclosure, she would probably have been better off stating the facts as neutrally as possible, with no more detail than was necessary, and returning to exploration of the clients' reactions and what meanings they associated with what they had learned.

3) She continues to over-share even after most of the group has moved on.

The therapist responds impulsively to goading from a client about "why she couldn't get a better job" (during a guided meditation, no less!), revealing that she is taking the test to get a real estate license...AND that she previously failed that test three times. 

While it's clear she wanted to prove that she is skilled and knowledgeable - that she can and will get a better job! - nothing good can come of what she shared there. She seems to regret it pretty quickly, but you can't unring the bell. Group members begin questioning her competence even more. In fact, they go so far as to directly ask her if she's stupid! 

If she had kept an eye on her own reactions and managed her feelings instead of allowing herself to be goaded, she could have kept the focus on the group and the activity. She could either have continue to explore their issues related to her competence and their own, or simply redirected the client who was goading her.

4) She lets it become about her issues

It goes downhill from there, as far as appropriate self-disclosure goes. To defend against the accusation that she is stupid, she goes into an emotional explanation of her test anxiety, down to the "inner voice telling her she's not good enough." While this may feel like a way of joining with and seeming relate-able to her clients, it instead puts them in a position of feeling like they have to take care of her. In fact, the first response from the group is "we can help!" 

Could this be empowering, for them to be able to help their therapist? Possibly. But it's also not really appropriate. The nature of the professional helping relationship is that it is all about the client's needs. We help them without asking for their help in return. It is a space for them to be vulnerable and needy, and they need to perceive us as strong enough to contain their affect. 

The end result? They come to her rescue (rather forcefully, in her defense), help her prepare, study, and go with her to the test, which she then passes, and gets a job as a real estate agent rather than a valet. Happy ending, in a total of 21 minutes of air time. 

What is the lesson in all that for handling self-disclosure?

1) The therapeutic relationship needs to stay therapeutic. Self-disclosure should only be done when it would serve the client in some way. The client should not feel the need to take care of us!

2) Self-awareness and monitoring of our own internal reactions is important, precisely so that we don't react defensively, over-share, or let something unhelpful slip inadvertently.

3) When clients do turn the attention onto us, the best response is to explore what is going on or coming up for them - what is the meaning they're ascribing to whatever it is they're bringing up?

4) When it's clear you can't keep something from coming out (say, if a client follows you to your second job...), it's best to state the facts as shortly and simply as possible. Handling things matter-of-factly puts people's minds at ease by communicating that it's not that big a deal. 

And finally, 5) like they say about commas: When in doubt, leave it out! (And use supervision or consultation to get clarity when there is uncertainty)

Modeling - What Is Normal, Anyway?

One of my jobs is at an eating disorders partial hospitalization and intensive outpatient program. A treatment goal for all of our clients, across the spectrum of eating disorders, is to "normalize" eating behavior. One of the main interventions by which we work on this goal is supervised meals. As staff, we often eat with the clients - to make it less awkward, and to model "appropriate" or "normalized" eating.

Therefore, a perennial question among staff is: What is appropriate to eat with clients? What is normal?

It's comparatively easy to determine whether clients are eating what they should be eating. They are all on meal plans, so we just have to make sure 1) that they're eating the exchanges that are on their meal plan for a given meal, and 2) that they aren't following "abnormal" eating rituals. The latter includes "diet" or "light" foods, unusual food combinations, unusual patterns of cutting/slicing/biting/pacing themselves, and excessive condiments, or foods not considered appropriate to the meal in question (e.g., waffles for grains at lunch).

While there is some variation in what staff consider normal vs. abnormal eating behavior for clients, it becomes even less clear when we stop to think about our own eating - and whether we can eat that way in front of clients. It's complicated by the fact that 1) we aren't on meal plans, 2) we tend to be willing to eat a wider variety of foods, 3) we can eat certain foods (e.g., lean cuisine or diet coke) without it being part of a dangerous cognitive, emotional, and behavioral pattern, 4) there is natural variability in what food combinations people and cultures eat, and 5) many or most women in this culture have some disordered eating habits.

The most cautious response is to have staff follow the program's standard meal plan when eating with clients. However, while safe, this strategy isn't necessarily "normalized." For example, the standard meal plan only includes 1 grain with lunch, but I like to have a sandwich, with 2 pieces of bread. Trying to develop a less rigid policy becomes tricky, however. We definitely don't want to eat diet foods in front of clients - we don't want to portray "normal" eating as having to choose diet or low-fat options! But, if we don't let them have soda, should I avoid drinking my regular coke in front of them? Can I drink water for a meal, if they're drinking milk? I'm not going to measure out my foods like they do (that's not normal), but will it therefore look like I'm eating less? The possible pitfalls are numerous, both because of the ranger of staff's personal preferences, and because we have no way of knowing exactly how clients are perceiving our behavior.

Another dilemma that comes up is how to "normalize" social interactions during meals. We want to model "normal" mealtime conversation, while also guarding against dysfunctional group dynamics (i.e., competition among clients). As a result of the latter consideration, we don't let them talk about food, meal plans, or what anyone is (or isn't) eating. However, it's very "normal" to talk about food during a meal! It's sometimes hard for me to remember not to comment on something smelling good, or to mention a favorite food, or whatever. Because eating is anxiety-provoking for clients, it's common for staff to offer some form of distraction, for example trivia or other group games. This habit is also not particularly "normal" - most people engage in small talk or conversation during meals. Therefore, I prefer to try to model mealtime conversational patterns by facilitating conversation.

However, that puts me square in the middle of another therapeutic quagmire: small talk involves some amount of self-disclosure. It's considered "small" talk because it steers away from areas that may be vulnerable...but, we know as therapists that any bit of self-disclosure may have some greater significance to clients, or impinge in some way on the clinical work (via clients' assumptions, judgments, assumptions about our judgments, sense of themselves as similar to or different from us...etc.). In modeling "normal" mealtime interactions, I'm sharing things I would most likely not share in the course of typical treatment - where I'm from, where I went to college, what sports team I root for, etc. Nothing huge, but still, little details about myself that might color a client's later interactions with me. What is safe to share, and what isn't? In a group setting, with high client turnover, it's hard to know for sure.

As you can see, the simple question of "what is normal" is incredibly complex when asked about meals in a treatment context. What we eat, do, and say - about anything - has clinical significance. I therefore have no simple answers to guide a policy for myself and colleagues. Do you face similar dilemmas in your work? What do they center around? How do you navigate these kinds of challenges?

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?