The Dilemma of Self-Disclosure

Source: © By Sasun Bughdaryan | Shutterstock

I have a client who is severely depressed and has been since I started working with her six months ago. She presents with passive suicidal ideation but says she doesn’t want to die; she merely wants the pain to end.

I tell her it will get better and that there is hope. She thanks me for that. I have no idea if she has Googled me and found my website that includes my detailed history or some of my published posts that also contain selected aspects of my illness. Sometimes when we are in session I want to tell her directly I’ve been where she is. I want to provide living proof that people do come back from the depths of the severe depression she has been experiencing. But I hold back because once I disclose, there is no going back.

In a study of the effects of therapist response modes in psychotherapy, Hill et al. stated that although TSDs (therapeutic self-disclosures) occurred only one percent of the time in their sample of therapy sessions, they received the highest client helpfulness ratings of all therapist responses.

This past week a client and I were chatting as our session opened about not looking forward to the upcoming winter. She asked if I had considered moving to Florida and I said no, because my family is in the Northeast. She asked me if I had a family of my own, meaning was I married. I don’t wear a wedding ring, which clients can see even if the sessions are virtual, so I answered truthfully. I said no, I never married. Was that too much to reveal?

For a 2005 study, Jean Hanson interviewed clients about their perceptions of disclosure and nondisclosure. Participants in this study indicated that therapist nondisclosures were likely to be unhelpful and to damage the therapeutic alliance, whereas TSD was likely to be helpful, contributing to the real relationship by providing clients with a sense of increased warmth and trust.

A new client called our practice and specifically requested that I be assigned as her therapist. This isn’t unusual; we all have separate profiles on Psychology Today's therapist directory and clients will often find us on there. I conduct all of the screening intakes for the practice and set up charts in our system for prospective clients. This client said she had been diagnosed with borderline personality disorder (BPD) and was very specific about the characteristics she was looking for in a therapist. She indicated she had been burned before. She was incredulous when she indicated she had found my website and discovered I was an experienced therapist who had recovered from BPD. She said I would understand what she has been going through.

In a 2010 study that also involved interviewing clients, Cristelle Audet and Robin Everall similarly discovered a link between TSD and the working alliance, indicating that TSD affects clients' willingness to disclose and consider therapeutically relevant information. Clients' confidence in therapists and in the working relationship was related to clients' sense of therapists' attunement to clients' issues, as reflected by therapists' TSDs, and TSD content relevance affected clients' levels of engagement. These authors highlighted that TSD of inappropriate or clinically irrelevant material could harm the working alliance.

My client who is depressed states she feels alone in her depression. It’s true that many people don’t know what to say to a person who is depressed and they tend to shy away from them, rather than draw a circle around them, just when they need that the most. I haven’t self-disclosed to my client about my depression.

In an effort to help her feel more understood, I directed my client to an essay by Kay Redfield Jamison published following the suicide of Robin Williams. I have never forgotten it because of how eloquently it describes the agony of suicidal depression. Part of it reads:

“Suicidal depression is a state of cold, agitated horror and relentless despair. The things that you most love in life leach away. Everything is an effort, all day and throughout the night. There is no hope, no point, no nothing.”

I hope my client can see that others have felt this way and have found their way out.

Thanks for reading.

Andrea

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.