A Little Self-Disclosure Goes a Very Long Way
By Heather G. Miller, LCSW
When most people think of inappropriate contact between a therapist and a client, they think of the usually publicized sexual relations between therapists and clients. However, there are other types of inappropriate relationships between clients and therapists which have been recently, hotly debated. These include acceptance of gifts, sharing personal information, and conducting meetings and/or long telephone contacts outside of therapy sessions. These types of contacts are also attracting more attention by licensing boards and other regulators (Psychotherapy Finances, May 2006). See also Malpractice & Licensing Pitfalls for Therapists: A Defense Attorney's List
Other than sexual relations, there is no agreed on definition of an inappropriate relationship between a client and therapist. Any one of the examples above may be appropriate considering the context, purpose, and number of times they occur. However, these types of contacts can contribute to a blurring of the therapist-client relationship, whether real or perceived by the client. They ultimately can result in malpractice allegations, loss of job and/or professional licensure. Therapists must decide whether engaging in the above behavior is worth the risk
While the exchange of money, gifts, other services, and contact outside the therapy session can all be measured and tracked, sharing of personal information is more intangible. Some therapists share personal information with clients when they believe it is in the best interest of a client, to help them work through an issue. However, once a client has personal information about a therapist, it’s very hard to prove that this information was shared strictly for the client and not the therapist’s benefit. The therapist could too easily use the session to take advantage of the client for personal gains, i.e. money and/or their own psychological needs.
There are several reasons that even an experienced therapist might inadvertently benefit psychologically from sharing personal information with a client. A common pitfall for therapists is ‘countertransference’ which according to the Merriam-Webster dictionary, is “1 : psychological transference especially by a psychotherapist during the course of treatment; especially : the psychotherapist's reactions to the patient's transference
2 : the complex of feelings of a psychotherapist toward the patient.” The therapist experiencing these countertransference feelings may try to take advantage of sessions to solve their own problems. It can also cause the therapist emotional pain and can render them less effective clinicians.
Counselors who were sexually abused as children are especially prone to possible countertransference in therapy sessions. Over the years, a few colleagues have disclosed their own sexual abuse on the Internet. Some posit that their own abuse increases their qualification to deal with this population. However, according to Maddy Cunningham in a NASW journal article, “…there is evidence that clinicians with a personal history of sexual abuse may find working with clients who were sexually abused distressful.” This can affect the therapy session in several ways. The clinician may experience a decreased ability to stay focused, offer suggestions based on their own circumstances instead of the client, or even experience intimate feelings for the client. Furthermore, according to Carolyn Knight, “…Reactions [of countertransference] range from avoidance of, to over identification with, the client and the material.”
Aside from countertransference issues, therapists who self-disclose about their own mental health treatment face questions about competence. Clients may complain (and perhaps rightly so) that their therapist was not equipped to handle their case due to their own mental health problems. Frederic Reamer describes impairment as “a) An inability and or unwillingness to acquire and integrate professional standards into ones repertoire of professional behavior b) Inability to acquire professional skills in order to reach an acceptable level of competency and, c) An inability to control personal stress, psychological dysfunction and/or excessive emotional reactions that interfere with professional functioning (my emphasis).” According to research cited on the NASW website: Social workers who are impaired in any capacity are at greater risk for unethical conduct and malpractice suits.
Therapists who are or have been in therapy can be effective clinicians, depending on the problem. In addition to sexual abuse survivors, I would also caution those who have experienced hallucinations or delusions and those recently combating drug and/or alcohol abuse. Those who have or who are thinking about disclosing their own mental health issues to a client should seek appropriate supervision (either within an agency or outside consulting if in private practice). After discussing these issues, it may be determined that the client needs to be referred to another therapist. Keep in mind that if a therapist chooses to share personal information about their own mental health treatment with a client, it could be more easily demonstrated that the clinician did so to benefit psychologically themselves.
Sharing personal information, especially mental health problems, with colleagues can be as detrimental as sharing with clients. I have met a few clinicians who have divulged their own mental health issues to colleagues for appropriate reasons. For example, to educate others that one had a successful practice while also in therapy, or to increase awareness of the process or usefulness of psychotherapy. Such disclosures have been on a limited basis and for a specific purpose, i.e. journal article, small discussion between professionals.
However, I have been increasingly disturbed over the years by therapists airing their own personal laundry, especially on the Internet. Disclosure of personal information on the Internet poses several problems: Clients and/or insurance companies have easy access to this information and documents remain on multiple machines for an indefinite amount of time. Internet companies (i.e. Yahoo, AOL) keep backups and archives of emails, message boards etc. Each user (such as me) may also keep archives and backups. It’s simply not a good idea.
Therapists need to be careful in revealing personal information to colleagues in general because it could diminish referrals to them and if a client and/or insurance company were to discover this information, it could lead to possible malpractice suits (see above). Take for instance, a woman who once publicly made known that she had failed her licensing exam three times. I would imagine very few colleagues would refer clients to her and a client could also potentially use that information in a lawsuit.
Mental health treatment disclosures to colleagues can also, in particular, lead to questions about competency. For example:
“Personally, I am in therapy…Prior to attending grad school, I made sure I had my therapist's assurance that I was okay to work with clients.”
This therapist is obviously confused between the role of a therapist and supervisor. A therapist is not in a position to assure competency of their clients to provide therapy themselves. A field instructor, professor and/or supervisor have the authority to evaluate work, give a stamp of approval for graduation, and deem an individual qualified to counsel others. Unfortunately, many professionals in psychology-related fields believe it’s possible for anyone to overcome the obstacles necessary to become a clinician. How many barriers to effective therapy or potential risks are allowable before therapeutic abilities are questioned?
Appropriate supervision can lessen the barriers to being an effective therapist and in particular, lessen the interference of a therapist’s mental health problems upon the client’s therapy session. Consider this recent posting from a colleague:
“Hi All. Before I became a therapist, I went through a number of years of therapy to clear out old family hostilities and other issues. Then, during a number of years of supervision, I worked on it some more. Now, I have studied myself a lot and constantly do a lot of self-analysis, even around things that might have occurred during sessions, just to keep myself straight. I think it is very important to be able to differentiate our selves from our clients' selves, and our stuff from theirs. Self analysis is an important part of the process, I feel, in order to stay balanced in the work and not get involved in projections and projective identification....(who am I and who is them?). It's never perfect of course, but I believe we need to have the intentionality to not get out stuff mixed into that of the clients. I'm not sure I put this all right. I'm writing fast because I have to get over to my office. But I think the point comes across.”
Here, I am less concerned about the specific disclosure made because the therapist sought appropriate supervision. However, lawyers have a saying, “A lawyer who represents himself has a fool for a client.” Therapists should consider the same. Participating in self-analysis may not sufficiently ensure that the clinician’s own mental health issues will not interfere with the client’s treatment. I also question the need to make public mental health treatment when the points could have easily been made by speaking in generalities.
A professional counselor should not disclose their own mental health problems either to clients or colleagues 1) while they are currently in treatment 2) if they have not been officially diagnosed, 3) while they are practicing, and definitely 4) NOT on the internet. Consider this posting of a well-respected colleague made on a message board of over 700 mental health professionals:
“In the past few years I have become more certain that I have ADD, and have done a fair amount of reading on the subject, which has helped me understand some previously confusing difficulties I have had. I literally cannot walk and talk about anything really absorbing, at the same time. Talk to me while I'm driving a car and I'm likely to have an accident. (With friends, I'm always the passenger.) Don't expect me to cook anything unless you want it burned. I suspect that I have a relatively mild case, and have found ways to compensate for the deficits over the years….Having a specialty in eating disorders, I am treating two bright adolescent bulimic girls with, until now, untreated, undiagnosed ADD. I am writing a paper to explain the coexisting conditions. They see themselves as such awful screw-ups, and see me, on the other hand, as a role model. With them, there is good reason to disclose about myself and I have. This has been very helpful to their parents too. And it has done me a world of good.”
First, if a client or insurance company saw this message, they could make the claim that this clinician is not competent to provide therapy. If talking impedes her walking and driving, how can she focus on a client for a 60-minute therapy session?
Also according to her message, even though she has suspected these problems for years, she is lacking an official evaluation and diagnosis by a professional. So while she may experience similar symptoms as her patients, she may not be suffering from the same disorder. Furthermore, even though she states that the patients see her as a role model, this may not be the case -- she may see herself as the role model due to countertransference. Either way, she does not have an adequate ‘good reason’ to disclose to the patients because her self-diagnosis may not be accurate. ‘And it has done me a world of good,’ may be an example of a therapist benefiting more from the therapy than her patients.
If you are a client and your therapist has made these kinds of disclosures to you, you may want to run it past a friend or another colleague to see if it is appropriate. If they seem to be talking about themselves for most of the session, perhaps you should consider if your money is being well spent. Before you even consider seeing a therapist, perhaps you should check some things on the internet first. If you are a therapist, perhaps you want to make use of some of the suggestions in this article such as seeking appropriate supervision and decreasing the sharing of personal information on the internet.
Remember, most therapists want to help their clients and do no harm – most therapists have good intentions. However, as most of us know, sometimes the best of intentions are harmful to others.
Resources:
Retrieved October 2006, from http://www.socialworkers.org/resources/abstracts/abstracts/profimpairment.asp
Maddy Cunningham, “Impact of Trauma Work on Social Work Clinicians: Empirical Findings” Social Work 48.4 (2003): 457
D.H. Lamb et al., “Confronting Professional Impairment during the Internship: Identification, Due Process and Remediation,” Professional Psychology: Research and Practice 18 (Year?): 595-603
Carolyn Knight, “Groups for Individuals with Traumatic Histories: Practice Considerations for Social Workers” Social Work 51.1 (2006): 24
Pope, Kenneth S. & Tabachnick, Barbara G. “Therapists as Patients: A National Survey of Psychologists' Experiences, Problems, and Beliefs,” Journal of Professional Psychology: Research and Practice 25.3 (1994) 247-258
Frederic G. Reamer, Social Work Values and Ethics, 2nd ed. (New York: Columbia University Press, 1999) 192-195
Heather G. Miller, L.C.S.W, is currently Clinical Supervisor at Jewish Family and Children’s Service in Philadelphia, PA. She has worked in the mental health field for over ten years providing individual, couples, family and group therapy to a diverse population. Ms. Miller is also actively involved with the Pennsylvania National Association of Social Workers (NASW) and serves on the state’s Political Action for Candidate Election (PACE) Committee.
