Self·Disclosure in the

Therapeutic Relationship
Self-Disclosure in the
Therapeutic Relationship

Edited by
George Stricker and Martin Fisher
Derner Institute of Advanced Psychological Studies
Adelphi University
Garden City, New Yark

Springer Science+Business Media, LLC

 Library of Congress Cataloging-in-Publication Data

Self-disclosure in the therapeutic relationship / edited by George

Strieker and Martin Fisher.
p. cm.
Includes bibliographical references.
ISBN 978-1-4899-3584-7
1. Psychotherapy. 2. Self-disclosure. I. Strieker, George.
II. Fisher, Martin, 1925-
RC480.5.S417 1990
616.89'14—dc20 90-6740
CIP

ISBN 978-1-4899-3584-7 ISBN 978-1-4899-3582-3 (eBook)

DOI 10.1007/978-1-4899-3582-3

© 1990 Springer Science+Business Media New York

Originally published by Plenum Press, New York in 1990
Softcover reprint of the hardcover 1st edition 1990

All rights reserved

No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
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Contributors

Sabert Basescu, Department of Psychology, New York University, New

York, New York 10003, and the Westchester Center for the Study of
Psychoanalysis and Psychotherapy, 516 Hommocks Road, Larchmont,
New York 10538

Laura S. Brown, 4527 First Avenue NE, Seattle, Washington 98105

Windy Dryden, Department of Psychology, Goldsmiths' College, Uni-

versity of London, New Cross, London SE14 6NW, England

Martin Fisher, Institute of Advanced Psychological Studies, Adelphi

University, Garden City, New York 11530

Mary Gail Frawley, Pomona Clinic, Robert L. Yeager Health Complex,

Pomona, New York 10970

Arlene Cahn Gordon, 15 Dogwood Drive, West Orange, New Jersey

07052

Lisa R. Greenberg, 428 Franklin Avenue, Nutley, New Jersey 07110

Bede J. Healey, Saint Benedict's Abbey, Atchison, Kansas 66002

James w. Hull, New York Hospital-Cornell Medical Center, Westchester

Division, 21 Bloomingdale Road, White Plains, New York 10605

Jonathan M. Jackson, Institute of Advanced Psychological Studies,

Adelphi University, Garden City, New York 11530

v
vi Contributors

Adelbert H. Jenkins, Department of Psychology, New York University,

New York, New York 10003

Lawrence Josephs, Institute of Advanced Psychological Studies, Adel-

phi University, Garden City, New York 11530

Robert C. Lane, Institute of Advanced Psychological Studies, Adelphi

University, Garden City, New York 11530

Esther Menaker, Postdoctoral Program for Training in Psychoanalysis

and Psychotherapy, Department of Psychology, New York University,
New York, New York 10003, and Private Practice, 20 West 77 Street, New
York, New York 10024

Nicholas Papouchis, Program in Clinical Psychology, Long Island Uni-

versity, Brooklyn Center, Brooklyn, New York 11201

Douglas J. Peddicord, 9402 Sunfall Court, Columbia, Maryland 21046

Judith C. Simon, 329 South San Antonio Road, Los Altos, California
94022

George Stricker, Institute of Advanced Psychological Studies, Adelphi

University, Garden City, New York 11530

Sophia Vinogradov, Department of Psychiatry, Pacific Presbyterian

Medical Center, San Francisco, California 94115

Lenore E. A. Walker, Walker and Associates, 50 South Steele Street,

Suite 850, Denver, Colorado 80209

Irvin D. Yalom, Department of Psychiatry and Behavioral Sciences,

Stanford University School of Medicine, Stanford, California 94305
Preface

The editors of the present volume were also privileged to collaborate on

an earlier book, Intimacy, also published by Plenum Press. In our pref-
ace to that volume, we described the importance and essence of inti-
macy and its centrality in the domain of human relationships.
After reading the contributions to that volume, a number of issues
emerged and pressed for elaboration. These questions concerned the
nature and parameters of intimacy. The natural extension of these con-
cerns can be found in the current work, Self-Disclosure in the Therapeutic
Relationship.
The editors, after careful consideration of the theoretical, philo-
sophical, and technical literature, are impressed by the relationship
between intimacy and appropriate self-disclosure. Self-disclosure, in
this context, refers to those behaviors that allow oneself to be suffi-
ciently revealing so as to become available for an intimate relationship.
Levenson has referred to psychotherapy as the demystification of expe-
rience wherein intimacy emerges during the time that interpersonal
vigilance diminishes through growing feelings of safety. Interpersonal
experience can be demystified and detoxified by disclosure, openness,
and authentic relatedness.
This is not an easy process. Before one can be open, make contact,
or reach out with authenticity, one must be available to oneself. This
means making contact with-and accepting-the dark, fearful, and of-
ten untouched areas within the person that are often hidden even from
oneself. The process of therapy enables those areas to gain conscious-
ness, be tolerated, and be shared with trusted others.
This book is about self-disclosure, with a focus on how it is under-
stood and utilized from a variety of different theoretical orientations
and with a variety of different patient groups. We have solicited chap-

vii
viii Preface

ters from a group of well-known and highly regarded authors who, in

their chapters, help to display a spectrum of attitudes and ideas about
self-disclosure and its role in the therapeutic process.

GEORGE STRICKER
MARTIN FISHER
Contents

PART I. INTRODUCTION

Chapter 1
The Shared Experience and Self-Disclosure. . . . . . . . . . . .. . . .. . . 3
Martin Fisher

Chapter 2
Self-Disclosure in Religious Spiritual Direction: Antecedents
and Parallels to Self-Disclosure in Psychotherapy. . . . . . . . . . . . . . 17
Bede J. Healey
Historical Perspectives of Self-Disclosure. . . . . . . . . . . . . . . . . . . . . . 17
Conditions for Self-Disclosure. . . .. . . . . .. . . . . . . . . . . .. . . . . . . . . . 19
Self-Disclosure in Religion and Psychotherapy. . . . . . . . . . . . . . . . . 21
How Spiritual Direction Differs from Psychotherapy. . . . . . . . . . . . 22
Self-Disclosure in Spiritual Direction. . . . . . . . . . . . . . . . . . . . . . . . . . 23
The Desert Fathers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Self-Disclosure in Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Conclusion. . . . .. . . . . .. ... . . . . . .. . . .. .. . . . . .. . . . . . . .. . . . . .. . 26
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

ix
x Contents

PART II. THEORETICAL PERSPECTIVES

Chapter 3
Self-Disclosure and Classical Psychoanalysis. . . . . . . . . . . . . . . . . 31
Robert C. Lane and James W Hull
The Problem of Self-Revelation ............................... 31
Self-Disclosure and the Early Analysts. . . . . . . . . . . . . . . . . . . . . . . . 33
Contemporary Views on Self-Disclosure. . . . . . . . . . . . . . . . . . . . . . . 37
Special Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Discussion ................................................. 42
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Chapter 4
Show and Tell: Reflections on the Analyst's Self-Disclosure 47
Sa bert Basescu

Chapter 5
Self-Disclosure in Rational-Emotive Therapy. . . . . . . . . . . . . . . . . 61
Windy Dryden
The Basic Principles of Rational-Emotive Therapy... . ..... . ... . . 61
The RET Approach to Client Self-Disclosure. . . . . . . . . . . . . . . . . . . 62
Therapist Self-Disclosure in RET. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Overcoming Obstacles to Disclosure in Clients and Therapists. . 71
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Chapter 6
Self-Disclosure in Psychotherapy and the
Psychology of the Self. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Lawrence Josephs
A Developmental Analog for the Process of Self-Disclosure in
Psychotherapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Implications for Psychotherapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Contents xi

PART III. THERAPEUTIC ISSUES

Chapter 7
The Role of Implicit Communication in Therapist
Self-Disclosure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Jonathan M. Jackson
Traditional Views of Self-Disclosure. . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Special Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Progressive Views of Self-Disclosure. . . . . . . . . . . . . . . . . . . . . . . . . . 97
Characteristics of Neutrality-Seeking Therapists. . . . . . . . . . . . . . . 100
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

Chapter 8
Transference, Countertransference, and Therapeutic Efficacy in
Relation to Self-Disclosure by the Analyst. . . . . . . . . . . . . . . . . . . . 103
Esther Menaker

Chapter 9
Self-Disclosure and the Nonwhite Ethnic Minority Patient 117
Adelbert H. Jenkins
The Racial Context of American Society . . . . . . . . . . . . . . . . . . . . . . . 118
Engaging the Minority Client in Psychotherapy. . . . . . . . . . . . . . . . 119
Managing the Early Sessions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
''Agency'' in the Minority Client. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Language and Psychotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 123
The Therapist's Skill: "Linguistic Competence". .. . . . . . . . . . . . . . . 124
Sociolinguistic Issues in Psychotherapy. . . . . . . . . . . . . . . . . . . . . . . 124
Self-Disclosure to Oneself. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 126
Some Dynamics of Language Difference in Therapy. . . . . . . . . . . . 127
Therapist Self-Disclosure .................................... 129
The "Contextual Unit" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
xii Contents

Chapter 10
Feminist Therapy Perspectives on Self-Disclosure. . . . . . . . . . . . . 135
Laura S. Brown and Lenore E. A. Walker
Introduction. . . . . . .. . . . .. . . . . . . . ... . . . . . . . . .. . . . . .. . .. . . . . . . 135
A Brief Review of Self-Disclosure in Feminist Therapy Theory. . . 136
Self-Disclosure in Feminist Therapy Theory.. . . .. . . . . . . .. . . . . . . 139
The Nature of Self-Disclosure in Feminist Therapy. . . . . .. . . . . . . . 141
Problems in the Use of Self-Disclosure in Feminist Therapy. . . . . 144
Current Applications of Self-Disclosure in Feminist Therapy. . . . 148
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

PART IV. THERAPEUTIC MODALITIES

Chapter 11
Self-Disclosure and Psychotherapy with Children and
Adolescents. .. . . . .. . . . . . .. . . . . . . . .. . . . . . . . . . .. . . . . . . . . . .. . . 157
Nicholas Papouchis
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
The Concept of Self-Disclosure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Self-Disclosure in Psychoanalytic Psychotherapy with Adults . . . 159
Self-Disclosure with Children and Adolescents:
A Developmental Perspective. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
The Therapist's Self-Disclosure with Adolescents. . . . . . . . .. . . . . . 167
The Therapeutic Alliance and Self-Disclosure.. . . . . . . . . .. . . . . . . 169
The Adolescent Therapist as an Object of Identification . . . . . . . . . 170
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
References ........ :. . . ... .. . . . . .. . . . . . . . . ... . . . . . . . .. . . . . . . . 172

Chapter 12
Self-Disclosure in Psychotherapy: Working with Older Adults 175
Lisa R. Greenberg
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Role of Self-Disclosure for Older People .. . . . . . . . . . . . . . . . . . . . . . 176
Psychotherapy and the Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Self-Disclosure by Therapist. . . .. . . . . . . . . .. . . .. . . . . . . .. . . .. . . . 183
Self-Disclosure by Older Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 185
Contents xiii

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

Chapter 13
Self-Disclosure in Group Psychotherapy. . . . . . . . . . . . . . . . . . . . . . 191
Sophia Vinogradov and Irvin D. Yalom

Patient Self-Disclosure in Group Psychotherapy. . . . . . . . . . . . . . . . 193

Therapist Self-Disclosure in Group Psychotherapy. . . . . . . . . . . . . . 198
Concluding Remarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 203
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 203

PART V. EXTRATHERAPEUTIC MANIFESTATIONS

Chapter 14
Criteria for Therapist Self-Disclosure 207
Judith C. Simon
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 207
The Study. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 208
Findings .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 209
Criteria .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 212
Modeling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 213
Discussion ........................................ . . . . . . . .. 220
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 224

Chapter 15
Self-Disclosure in Holocaust Survivors: Effects on the Next
Generation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 227
Arlene Cahn Gordon
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 227
Self-Disclosure in Stages of Survival. . . . . . . . . . . . . . . . . . . . . . . . .. 228
Self-Disclosure: A Developmental Framework. . . . . . . . . . . . . . . . .. 232
Referential Activity: A Measure of Self-Disclosure. . . . . . . . . . . . .. 233
The Study of Self-Disclosure in Survivors and Their Children. .. 234
Unique and Universal Implications. . . . . . . . . . . . . . . . . . . . . . . . . . .. 237
Therapeutic Implications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 242
xiv Contents

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .. 243
References.... . . . . . . .. . .. ... . . . . . . . .... . . . . . . . ... . . . . .. . . . .. 243

Chapter 16
From Secrecy to Self-Disclosure: Healing the Scars of Incest. .. 247
Mary Gail Frawley

Chapter 17
Issues in the Disclosure of Perinatal Death ...... . . . . . . . . . . . . . 261
Douglas]. Peddicord
The Problem of Perinatal Death. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Unique Characteristics of Perinatal Death ....... ; . . . . . . .. . . .. .. 262
The Impact on Parents.............. .................... ..... 264
Barriers to Disclosure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 267
Self-Disclosure and Its Effects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
References. . . .... .. . . . . . . . . . . .. . . . . . . . . .. . ... . .. . . .. . . . . . . .. 272

PART VI. CONCLUSION

Chapter 18
Self-Disclosure and Psychotherapy. .. . . ... . . . . .. . ... . . . . . . . .. 277
George Stricker

Index...................................................... 291
 I
Introduction
 1
The Shared Experience
and Self-Disclosure
Martin Fisher

In a chapter prepared for a book I had previously coedited (1982) I wrote

about an approach to psychoanalytic psychotherapy that was referred
to as lithe shared experience." It was my belief then, as it continues to be
now, that when patients present'themselves for psychotherapy they are
looking for a solution to loneliness or, more specifically, a "cure" for a
lack of intimacy.
I write this chapter with a particular bias. Regardless of symptom,
presenting complaint, or clinical diagnosis, I believe that patients pre-
sent themselves for psychotherapy because of the inability (with or
withou t awareness) to have and/or to be in intimate relationships. Some-
where, somehow, because of intrapsychic and/or interpersonal deficits,
the individual comes to feel his/her aloneness, fear, and vulnerability.
The patient, through the transference as well as the real relationship
with the therapist, tries to capture (or recapture) this state of grace
referred to as intimacy. The openness, closeness, and appropriate de-
pendency that makes up intimate relatedness, will be woven silently or
overtly in the patients' attempts at recovery of the lost or disordered self.
How does this alienation from self and others occur? What are the
existential manifestations of such a process? One way of conceptualiz-
ing this experience of disordered affective and cognitive experiences
looks something like the following:

Martin Fisher. Institute of Advanced Psychological Studies, Adelphi University,

Garden City, New York 11530.

3
4 Martin Fisher

1. The infant/child is constantly involved in a communication loop

with significant others, which produces either positive or nega-
tive feedback.
2. Negative feedback results eventually in a psychic withdrawal
from the outside and results in the growth of "secrets." (The child
is encouraged to keep secret those feelings, ideas, and behaviors
that result in some overt or covert form of punishment or
rejection. )
3. Early in the development of the ego, an accumulation of "secrets"
builds in which the authenticity of the child becomes coarctated
and results in an accumulation of negative feelings and ideas that
then make up the nucleus of unconscious existence.
4. Since these secrets represent the dreaded aspects of existence (in
the eyes of important others), their disclosure would lead to a
disaster, that is, a disintegration of the "I" that was created for
acceptance and the visibility of the "not I" that the child tried so
hard to disguise.
5. The greater the degree of "secrets," the greater the degree of
alienation from the self. The greater the alienation of the self, the
greater the alienation from others.
6. The greater the alienation from self and others, the greater the
loss of real intimacy in interpersonal relatedness. (Fisher, 1982)
At this point, I would like to address myself to the cornerstones of
psychoanalytic inquiry, namely, anxiety, transference, and resistance.
Specifically, the typical pattern is that under the impetus of anxiety,
the individual often utilizes the transference in order to act out the
resistance. In like fashion, we now know and understand that this expe-
rience of the patient is often met by the counteranxiety, the counter-
transference, and the counterresistance of the analyst. What then takes
place in the arena of p'sychoanalysis is inextricably woven and inter-
woven in a combined interaction between patient and analyst. Who is
influencing whom, at any given moment, and in what direction, to what
end, as a function of that interaction? This is what may be referred to as
the psychology of "shared experience" (Woldstein, 1971). I will return to
this idea shortly.
Many contributors to the thinking and theorizing of psycho-
analysis have referred to this idea of shared experience in a variety of
ways. Sullivan (1953) used the term "collaboration" and described it as a
mutually rewarding relationship that promotes a reciprocal validation of
personal worth. Frank (1977) describes the therapeutic dyad as being
... of limited value unless implemented within a relationship characterized
by an affectional bond of mutual trust and respect, and where the analyst is
willing to fully experience and to be experienced, on an authentically human
level. (p. 6)
The Shared Experience and Self-Disclosure 5

Searles contends that if the therapist's and patient's mutual thera-

peutic endeavor is to prove successful, then both patient and therapist
must discover "hope" in their collective experience together (in Frank,
1977). Paul Olsen (in Frank, 1977) defines psychotherapy as
... a contact not just between two people engaged in some sort of interperso-
nal activity on a seesaw of transferential distortions and the "real" relationship
but a communion of two souls-a conception for which he expands thera-
peutic possibilities and, indeed, enriches relationships in general. (p. 141)

Finally, Singer suggests that if the goal of therapy is the growth of

the capacity to develop intimate knowledge of one's own personal expe-
rience and the comparable knowledge of the experience of others, then
the nature of therapeutic intimacy and the resulting exchange must be
our starting points for mutual growth (in Frank, 1977, p. 191).
In short, what I and others are calling a shared experience has been
referred to in the psychoanalytic literature in a variety of ways; but they
essentially describe a similar or identical notion.
First, allow me further to specify the psychodynamic parameters of
resistance, which, as a phenomenon, became apparent in the early work
of Freud. Attention was paid to resistance as a necessary and intrinsic
issue to be confronted in psychoanalysis. In Lecture XIX of the Introduc-
tory Lectures on Psychoanalysis, Freud (1966) observed:
Resistances ... should not be one-sidedly condemned. They include so much
of the most important material from the patient's past and bring it back in so
convincing a fashion that they become some of the best supports of the
analysis if a skillful analyst knows how to give them the right turn. Nev-
ertheless, it remains a remarkable fact that this material is always in the
service of the resistance to begin with and brings to the fore a facade that is
hostile to the treatment. (p. 291) (emphasis mine)
Here then is the cornerstone of much that follows. Resistance, that
profound quality of the human psyche to avoid knowing lies at the roots
of our endeavors to explore in psychoanalysis. Freud (1966) always felt
that one of his great discoveries was the avoidance of knowing which he
termed "resistance." He wrote:
In the first place, then, when we undertake to restore a patient to health, to
relieve him of the symptoms of his illness, he meets' us with a violent and
tenacious resistance which persists throughout the whole length of treat-
ment. This is such a strange fact that we cannot expect it to find much
credence .... The patient too, produces all the phenomena of this resistance
without recognizing it as such, and if we can induce him to take our view of
it and to reckon with its existence, that already counts as a great success.
Only think of it! The patient, who is suffering so much from his symptoms
and is causing those about him to share his sufferings, who is ready to
undertake so many sacrifices in time and money, effort and self-discipline in
order to be freed from these symptoms-we are to believe that this same
6 Martin Fisher

patient puts up a struggle in the interest of his illness against the person who
is helping him. How improbable such an assertion must sound! Yet it is true;
and when its improbability is pointed out to us, we need only reply that it is
not without analogies. A man who has gone to the dentist because of an
unbearable toothache will nevertheless try to hold the dentist back when he
approaches the sick tooth with a pair of forceps. (pp. 286-287)
In this description Freud has outlined the profound essence of what
sets psychoanalytic inquiry apart from other psychotherapies that are
not described as psychodynamic in nature.
In a chapter that I wrote for a previous volume (1982), I point out
what seemed to me a critical distinction between the Freudian view of
resistance and an existential exploration referred to by Bugental (1965).
As significant a place as Freud accords the resistance, existential-
analytic theory regards this discovery as even more fundamental. The
resistance shown by the patient in the therapeutic session-the ways in
which he/she avoids awareness, displaced responsibility, maintains his/
her alienation, and so on-is the very pattern through which the patient
maintains hislher inauthentic relation to life, is the very source of his
nonbeing (p. 88).
In the above model, Freud implies that the patient's resistance is to the
process of psychoanalysis and/or the psychoanalyst and results in the pa-
tient's unconscious avoidance of these external forces. Freud emphasizes this
idea when he writes: I cannot recommend my colleagues emphatically
enough to take as a model in psychoanalytic treatment the surgeon who puts
aside his own feelings, including that of human sympathy .... The justifica-
tion for his coldness in feeling in the analyst is that it is the condition which
brings the greatest advantage to both persons involved. (191211964)
Freud (1949/1964) makes a clear-cut distinction between analyst and
patient, with the analyst invariably being the more "grown-up" of the
two. He makes this explicit when he states: "Too many neurotics have
remained so infantile that in analysis too they can only be treated as
children."
Another view of resistance, more consistent with my own, is ex-
pressed by the existential psychoanalyst Bugental (1965). In his book
The Search for Authenticity, Bugental contends that
... the resistance is the shield the patient erects to forestall the feared con-
frontation with the reality of his being in the world. (Thus, the therapist who
thinks of the resistance as a warding off of his own efforts misses the point
and confuses the patient.) The therapist's task is to help the patient redis-
cover the conflict within himself that gave rise to the resistance and other
defenses and constrictive maneuvers. (p. 43)
In truth then, the patient resists not the therapist and/or therapy but
the dread of discovering himself. As Bugental continues,
Resistance is the name that we give to the general defensive wall the patient
The Shared Experience and Self-Disclosure 7

puts between himself and the threats that he finds linked to being authentic.
Resistance is (simply) anti-authenticity. (p. 43)

We have moved, then, away from the psychoanalyst's couch into the
wider and real-life experience of the world.
The existential model of resistance implies threat. Simply stated, it
represents the threat of nonbeing. The resistance, then, is humanity's
constant effort to avoid the pain of feeling, thinking, or reexperiencing
nonbeing. There seems little doubt that the prototype for this potential
nonbeing lies in the early traumatic feelings of potential nonbeing that
each separation repeatedly arouses in the infant.
In viewing Freud's model, he implies that the patient's resistance is
to the process of psychoanalysis and/or the psychoanalyst and results
in the patient's unconscious (and sometimes conscious) avoidance of
these external forces. In reviewing Bugental's and the existential posi-
tion the resistance can be seen to be a fear and avoidance of the patient's
own self-induced (conscious and unconscious) meeting the real (au-
thentic) self; the fear of discovery, the fear of being seen as, or feeling in
some way, damaged. The patient then is avoiding coming to terms with
his/her own existence in the belief that he/she is somehow bad and/or
damaged and rejectable.
At this time it should be noted that resistance is not confined to the
analytic consulting room; neither is the transference phenomenon
which is also in the service of the resistance. These two phenomena
(transference and resistance) are now readily recognized to be ubiqui-
tous and are present in the individual in therapy as well as in those who
never see the inside of a therapy consulting room.
A further extension of the existential view is that humans seek to
avoid anxiety-the anxiety of freedom. Freedom represents a world of
increased contingencies. An increase in contingencies represents more
possibility of failure, rejection, and loss of self-esteem. More pointedly,
however, this same acceptance of freedom brings the reality of ultimate
nonbeing (death) painfully into awareness.
Think, if you will, what is implied in the existential view of authen-
ticity; authenticity representing the antithesis of resistance. Bugental
suggests that the authentic person is, at first, broadly aware of himself,
his interpersonal relationships, and all dimensions of his real world.
Secondly, the authentic person accepts the fact that life represents
choices, that he goes forth to meet those choices, and that decisions are
the very stuff of life. And third, the authentic person assumes full re-
sponsibility for approaching these contingencies, making decisions,
and accepting full responsibility for his acts.
It is agreed that transference is unconscious and distorted (by defi-
nition) and arises out of early childhood experiences.
8 Martin Fisher

In a recent paper Goldman (1988) refers to the concept of a paradise

lost which the child experiences in his/her coming to terms with exis-
tence. Goldman suggests that
... (for) patients who experience this deep core of sense of essential inner
badness or defectiveness, which often borders on a feeling of being personally
evil, there is an underlying and almost always unconscious fantasy of havirig
been the wicked destroyer of a preexisting paradise. What I mean by this is
that the person unconsciously believes that before his or her conception and
birth, there existed a state of paradisiacal unity and bliss between the parents
and an essential goodness in the family situation that was ruptured by the
child's advent and thereby irretrievably lost. This is a specific way in which
the child blames him or herself for the pain and difficulty of a family situation
structured by narcissistically deprived and damaged parents. (p. 420). .

It has been said in the psychoanalytic literature that once a patient is

fully capable of "free association" the analysis is over. This idea lies at
the heart of the engagement between patient and analyst. Further, it
establishes the essence of what brought about the need for the analysis
in the first place.
We develop or create "secrets" in childhood in an attempt to avoid
reflection. Because these secrets move into that sphere, or become part of
what we refer to as the unconscious, the secrets are not even known to
the patient. Since we have, in effect, gone underground, we have limited
our ability to be in or to have intimate relationships. It is my thesis that
intimacy is the desired goal in life and that self-disclosure is the route to
intimacy. A clinical example may help illuminate this point.
John, a patient in therapy for three years (three-time-a-week indi-
vidual psychoanalysis), was having a very difficult time trusting anyone.
The evidence was clear in behavioral as well as verbal communications.
Early profound experiences were obliterated from his memory. The
facts, however, were that, after the death of his father, he had lived in 13
foster homes from age 2 until the age of 12, when he returned to live
with his biological mother. His lack of basic trust was so pronounced that
he created a world in which he always had to be dominant. This meant
controlling people (his wife, four children, the analyst, his professional
colleagues, and so forth) lest someone "do him in."
As the characterological layering was peeling off, John reported the
following scene. The previous day he had attended the funeral of a
friend and neighbor. As the funeral procession formed to leave for the
cemetery, his 18-year-old daughter expressed the wish to offer condo-
lences to the daughter of the deceased as she was preparing to enter the
funeral car. John immediately explained that this was inappropriate and
intrusive. Nevertheless, his daughter proceeded to walk up to the young
girl, who in turn expressed great warmth and appreciation at John's
daughter's gesture. When his daughter returned to John's side, she com-
The Shared Experience and Self-Disclosure 9

mented on the discrepancy between John's advice and the outcome of

what she had done. In reply, he admitted that he was ashamed and
afraid to do what his daughter had done. Rarely, if ever, had he admitted
to anyone so close to him something that might make him seem less
than perfect. His daughter's reaction was surprise, delight, and a wish
to be closer to her father who acknowledged a possible flaw in his
"invincibility."
It is most important to note that the example suggests more than
trust in his daughter by John. It demonstrates, even more profoundly,
John's basic trust in revealing himself to himself in public. In this exam-
ple, John decided to "share" his experience with his daughter because of
a growing feeling of trust.
I would like to pursue further the notion of the "shared experience."
In studying this construct called "shared experience," the idea seemed
clearly to be a recreation of a caution that all psychoanalytic therapies
attend to; specifically, that the work area or arena of psychoanalytic
inquiry lies at the interface of the anxiety, transference, and resistance of
the patient and the counteranxiety, countertransference, and counter-
resistance of the analyst.
This led to my belief that shared experience cannot take place between
unequals. Something can only be truly shared by equal co-participants.
Yet, if one reviews earlier formulations of psychoanalysis, the oppor-
tunity for shared experience disappears. In the id/biological model, the
psychoanalyst was expected to be a blank screen intended to encourage
regression so as not to distort the patient's transference behavior. In the
interpersonal model of psychanalysis, the therapist is expected to be a
participant-observer. Although this model includes participation, it
would seem more appropriate to have two participant-observers. Just as
Sullivan hypothesized that the patient brings into the therapy room
many additional people (transferentially from early experience), so does
he meet many more people in the therapy room than his psychoanalyst.
It is the thesis of this chapter that alienation from self and others is at the
root of psychopathology. The modes of inauthentic being come into play
as the individual moves further and further away from life and all of the
(treacherous) contingencies that we all must face but too often are fear-
ful of. Yalom (1980) describes these life concerns as freedom, aloneness,
meaning, and death. Of course, we as humans have no choice but to
engage these issues. But they frighten us into avoiding (or trying to
avoid) each of them. As though we could truly avoid death! But we try;
and in so doing create an inauthentic life.
When our patients present themselves for psychotherapy, our real
task is reclamation. It seems to me that the reclaiming of the self is
through the process of coming to terms with and being in an intimate
10 Martin Fisher

relationship. It seems, then, most obvious that intimacy should occur in

therapy, as a prelude for intimacy in life with others, through the process
referred to in this chapter as self-disclosure. What is the essence of self-
disclosure? Earlier it was suggested that the analysis would end when
free-association was fully achieved. Why should this be so difficult to
come by? Why are we so afraid of disclosing ourselves? It must be that
what we know is too threatening (fear of rejection) or that we no longer
consciously are fully aware of those feelings and ideas that we still
continue to try and hide. It is as though we must have assurance that
who we are, what we say, the ideas we believe in must be guaranteed
acceptance, or we face the inevitable fate of rejection (which to the infant
is tantamount to death). Bugental (1965) suggested that contingency
(choices) is the very stuff of life:
... Once we know all that we need to know in order to make a decision, we no
longer make a decision but are determined by what we know. The joy in life
comes from making decisions and becoming affirmed. Here then lies the
threat in self-disclosure. Will the patient discover that in chance-taking (of
opening oneself to another) he or she will be humiliated, rejected, or still
worse, destroyed? Or, as I suggested earlier, have these aspects of the self
been so thoroughly pushed into the unconscious that without the efforts of
psychoanalytic psychotherapy they are not even available for expression?

Clearly, the sense of this essay suggests that alienation, which is a

result of withholding thoughts and feelings from others, lies at the root
of psychopathology. In order for the individual to reclaim aspects of his/
her real self, it is necessary to become self-disclosing to an other, and
others in general. I believe that this process can best occur in a relation-
ship that encourages sharing of feelings and ideas. This relationship can
best be achieved in an engagement of co-equals in the therapeutic rela-
tionship. This last idea is the one that probably raises the most ques-
tions. Can therapist and patient truly be in an equal relationship? I
believe so.
In a previous paper (1982), I suggested that the paradigm of the
dyad in psychoanalysis is the recreation of the relationship between
parent and child. I referred, then, to Erickson's (1963) epigenetic dia-
gram of interpersonal ego-psychological formulations. In Erickson's
terms, the infant's first psychological task is achieving a sense of "basic
trust." The alternate polar solution for the infant is the experience of
"basic mistrust." Obviously, for most people the solution of this early
period is not absolute, but lies at some point in between. The individual
who arrives as a patient some 20 or 30 years later is caught in some
dilemma of being unable to trust in human relationships. More impor-
tantly, and this issue is critical, in opening himself up to another, the
patient is really risking opening up to himself. He must trust the hid-
den, secretive self to be revealed to the analyst in the context of trust so
The Shared Experience and Self-Disclosure 11

that his discoveries and revelations will not result in his own rejection (at
least) and his psychological death (at worst).
What emerges in the diminished capacity for basic trust appears to
be the loss or diminution of intimate relatedness. Distrust encourages
"secrets" (banished to the preconscious or unconscious); intimacy
(shared experience) encourages openness.
The literature that points to the effect on the infant of mothering
(parenting) is rich and voluminous. A. Balint (1965) points out that
... maternal love is the almost perfect counterpart to the love for the
mother .... Thus, just as the mother is to the child, so is the child to the
mother-an object of gratification. And just as the child does not recognize
the separate identity of the mother, so the mother looks upon her child as part
of herself whose interests are identical with her own. The relation between
mother and child is built upon the interdependence of the reciprocal instinc-
tual aims. What Ferenczi said about the relation of man and woman in coitus
holds true for his mother-infant relation. He meant that in coitus there can be
no question of egoism (love interest of the self) or altruism (love interest of
the other); there is only mutuality, i.e., what is good for one is right for the
other also. In consequence of the natural interdependence of the reciprocal
instinctual aims there is no need to be concerned about the partner's well-
being. (p. 101)

M. Balint continues this thinking when he reflects:

I am rather sad that nobody mentioned the name of Sandor Ferenczi who first
called our attention to the fact that the formal elements of transference and
the whole analytic situation derive from very early infant-parent relation-
ships .... Perhaps the most important lesson that we can derive from this is
that the basis of the infant-parent relationship is in mutual interdependence
of the two .... That is, what is libidinal satisfaction for the one, the infant,
must be libidinal satisfaction for the mother, and vice versa .... One of the
consequences of this idea is that something similar must obtain also in the
relationship between the analyst and patient. (p. 145)

More recently, Peterson and Moran (1988) in reviewing 'l\.ttachment

Theory" as explicated by Bowlby, point out that a number of studies
strongly suggest that " ... mothers of more securely attached infants
appear to be more confident, emotionally stable, and responsive to their
infants' attachment behaviors than mothers of insecurely attached in-
fants. Further, mothers suffering from mental illness and those who
neglect or abuse their children tend to have insecurely attached infants"
(p.623).
Given the foregoing, it is the thesis of this essay that "shared"
experience can only take place between equals. And this equality de-
mands that while the patient can only achieve wholeness (intimacy)
through self-disclosure and openness, the therapist too must be en-
gaged in his/her own self-disclosure and openness to his/her patient.
The issue, then, hangs on the notion that no infant child can grow
12 Martin Fisher

beyond the willingness or capabilities of the parenting figure. In like

fashion, no patient can ever move, or grow beyond his or her analyst's
(conscious and unconscious) willingness to let himlher move and grow
toward greater intimacy.
How, then, does the analyst share or reveal hislher own secrets,
feelings, ideas, unconscious, etc.?
Only through an experience of real intimacy can authentic behavior
and creation or recreation take place. I have now used the concept of
intimacy as synonymous with shared experience. How can anyone truly
share an experience, thought, or idea without exposing some of his
secret self, unless there exists the potential for intimacy? How can any-
one truly expose his authentic, original, changing, and emerging
psyche, unless he has experienced himself in a truly intimate relation-
ship? The variable necessary to achieve or approach such a state of grace
lies in the concept of basic trust. This climate would then be necessary in
the therapy alliance.
With specific regard to trust, the notion of the importance of the
mother-child relationship was elaborated by Roy Schafer (1973) in refor-
mulating his position on resistance. He advances the idea that Freud
overvalued the concept that resistance has its prototype in the authority
of the father in the oedipal situation. Schafer (1973) suggests that
Freud did not teach us to appreciate the fundamental developmental impor-
tance of the infant's prolonged helplessness and of the early danger situa-
tions corresponding to this helplessness, especially of the loss of the love
object and loss of love .... The prospect of being abandoned by her (mother)
physically and emotionally, really or in fantasy, never loses its painful if not
terrifying aspect .... Anxiety over losing the mother or her love threatens to
undermine the boy's and the girl's very sense of worth or right to exist .... If
we think of the analysand as defying the archaic mother's authority too, we
will think as well of the growing importance to the child of differentiating
himself from his mother .... By dint of these strivings the child establishes
and maintains differentiation and wards off its wishing to merge with the
mother through incorporation as well as the mother's seductions to merge
and her devouring approaches. (p. 270)

A number of possibilities emerge in the repertoire of the psycho-

analyst that can be seen as sharing. In our sharing mode, we inevitably
reveal ourselves, wittingly or unwittingly. I would suggest that if we
consciously choose to share, we offer the gift of intimacy to our patients.
Some of our sharing seems readily apparent. When we engage our
patients through empathy, we have opened a possibility of sharing.
When patients disclose seemingly helpless feelings regarding decisions
in their lives we often suggest "alternative solutions." This very behav-
ior is an act of sharing. When we speak to the patient's repressed
thoughts or feelings we enter into a mode of sharing and intimacy.
The Shared Experience and Self-Disclosure 13

However, the most profound opportunity for sharing, it seems to

me, is the essential and significant use of the analyst's counter-
transference. To understand the implications of the uses of counter-
transference I refer to the seminal work of H. Racker (1968), in which he
contends that
... Countertransference reactions of great intensity, even pathological ones,
should also serve as tools. Countertransference is the expression of the an-
alyst's identification with the internal objects of the analysand as well as with
his id and ego, and may be used as such. Countertransference reactions have
specific characteristics (specific contexts, anxieties, and mechanisms from
which we may draw conclusions about the specific character of the psycho-
logical happenings of the patient. (p. 129)

Racker feels even more strongly that uses of countertransference go

beyond revealing of the self of the analyst to the patient. He infers that
the reciprocity of transference and countertransference is critical in the
unfolding of the analysis. He notes that " ... the influence of counter-
transference upon the analyst's behavior toward the analysand - behavior
that affects decisively the position of the analyst as object of the reex-
perience of childhood, thus (affects) the process of cure" (p. 129).
Most practitioners and students of psychoanalysis are already
aware of the strict prohibitions of the early writers and practitioners of
psychoanalysis to rid oneself of countertransference so that the analytic
enterprise could proceed smoothly and without the interference of the
analyst's subjective ;md objective countertransference issues. There is
wider acceptance in more recent writings about theory and practice that
countertransference may be the most crucial tool in contacting the pa-
tient's repressed and heretofore unavailable feelings and communica-
tions in the psychoanalytic arena. Racker clearly represents this later,
more recent view.
There are a number of technical issues about how, when, where,
and why the analyst in the psychoanalytic dyad would or should reveal
countertransference which becomes conscious. This paper will merely
suggest that countertransference revealed (timely and appropriately)
sets the stage for the psychology of a "shared experience." It is this
shared experience that undoes the malignancy of early developmental
"secrets" between child and parent. It is this process that makes the
products of malignancy benign and therefore safe.
In closing, I refer to a description of psychopathology that was
suggested by E. Levinson and elaborated in Group (1977). Levinson
proposed three somewhat different major sets within the psycho-
therapeutic process that need to be addressed if intimacy is to be
achieved. He described these as (1) desensitization of experience, in
which the achievement of intimacy is a direct goal; (2) detoxification of
14 Martin Fisher

fantasy, which will or should lead to healthy personal experiences from

which intimacy will ensue; and (3) demystification of experience,
wherein intimacy emerges as interpersonal vigilance diminishes through
feelings of safety (p. 16) (emphasis mine).
Given the expectations of the dynamics of a truly shared experience
between patient and therapist, it is my belief that all three descriptions
outlined by Levinson are likely (positive) outcomes of a well-conducted
psychotherapy encounter. Further, I contend that for a genuine encoun-
ter to occur between patient and therapist, and for authentic growth in
intimacy to emerge (which is at the heart of the need for therapy to begin
with) a truly shared experience must take place. Again, the belief herein
suggested is that the encounter between patient and therapist (like that
between parent and child) should take place between (psychological)
equals: between the co-participants of dyadic psychotherapy. Lastly,
that the sharing of experiencing, which leads to intimacy, is achieved
through the process of (mutual) self-disclosure.
An excerpt from a recent volume on Psychotherapy (Gilliland et al.,
1989) summarizes the point:
... the most important element in counseling is the personhood of the coun-
selor. The most powerful impact on the client may be that of observing what
the counselor is and does. Counseling is collaborative. It is something two
people do together. The counselor must be willing to invite the client to
interact with a person (the counselor) who is also struggling, evolving, risk-
ing, evaluating self, problem-solving, and experiencing all the normal hu-
man emotions from severe grief to ecstasy. It is important for clients to view
counselors as people who are competent (but not perfect), mature, stable,
persevering, and continually learning and growing. It is also important for
them to understand that counselors are fallible, and can experience ambiva-
lence, failure, frustration, and change .... Effective counseling cannot be separated
from effective living. (p. 7)
I believe that most patients come to therapy in order to become a
"better" human being. Psychotherapy becomes the route to so-called
self-improvement. I believe that too many psychotherapists accept this
definition of psychotherapy and try to help their patients "improve." I
believe that the goal of psychotherapy is acceptance of the self as it is.
With acceptance of the real self comes a diminution of the need to create a
false self and the ability and opportunity to be the authentic self. Once you
accept who you really are, you can be or become anyone you want to be.

References
Balint, A. (1965). Primary love and psychoanalytic technique (M. Balint ed.) New York:
Liveright.
Balint, M. (1965). Primary love and psychoanalytic technique (M. Balint ed.) New York:
Liveright.
The Shared Experience and Self-Disclosure 15

Bugental, J.ET. (1965). The search for authenticity. New York: Holt, Rinehart & Winston.
Eisenbud, R.J. (1977). Personal communication.
Erikson, E. (1963). Childhood and society. New York: Norton & Co.
Fisher, M. (1977). The potential for authentic relatedness in group psychoanalysis. Group
Process, 7 (2), 141-150.
Fisher, M. (1983). Intimacy. (M. Fisher & G. Stricker Eds.) New York: Plenum.
Frank, K. (1977). The human dimension in psychoanalytic practice. New York: Grune &
Stratton.
Freud, S. (1966). The complete introductory lectures on psychoanalysis. New York: w.w. Nor-
ton. (Originally published, 1917).
Goldman, H.A. (1988). Paradise destroyed: The crime of being born. Contemporary Psycho-
analysis, 24, (3), 420-450.
Gilland, B.E., James, R.K., & Bowman, J.T. (1989). Theories and strategies in counseling and
psychotherapy (2nd ed.) Englewood Cliffs: Prentice Hall.
Peterson, R., & Moran, G. (1988). Attachment theory. Clinical Psychology Review, 8, (6),
611-636.
Racker, H. (1968). Transference and countertransference. New York: International Universities
Press.
Schafer, R. (1973). The idea of resistance. International Journal of Psychoanalysis, 54, 259.
Wolstein, B. (1971). Human psyche in psychoanalysis. Chicago: Ill: c.c. Thomas.
Yalom, I. (1980). Existential psychotherapy. New York: Basic Books.
 2
Self-Disclosure in Religious
Spiritual Direction
ANTECEDENTS AND PARALLELS TO
SELF-DISCLOSURE IN PSYCHOTHERAPY

Bede J. Healey

Historical Perspectives of Self-Disclosure

Self-disclosure is a process integral to both psychotherapy and religious
experience. Other authors in this book discuss the role of self-disclosure
in the therapeutic relationship; I offer an overview of the role of self-
disclosure in Judeo-Christian religious experience, with' a special em-
phasis on self-disclosure in the process of Christian spiritual direction.
It is not unusual to consider religion and psychotherapy together.
Both are concerned, after all, with healing and the exploration of mean-
ing. From a religious perspective, self-disclosure has a long history.
Long before psychology was a discipline, or psychotherapy existed as a
profession, the psychological processes that are now associated with
psychotherapy were the domain of the priests and healers of society.
May (1982) points out that up until the time of the Protestant Reforma-
tion, there was little distinction between spiritual and psychological
issues. With the discoveries of Freud, May believes psychology and
psychiatry became the "new priesthood" (p. 2).
In the Judeo-Christian traditions, religion and religious experience
are relationship-based: "Thus the Lord used to speak to Moses face to
face, as a man speaks to a friend" (Exodus 33:11, RSV). An integral part

Bede J. Healey • Saint Benedict's Abbey, Atchison, Kansas 66002,

17
18 Bede J. Healey

of this relationship is self-disclosure. It is possible to look at the story of

the fall of Adam and Eve as a rupture in this relationship, whereby
shame and the need to cover up and hide came into being, thus intro-
ducing a burden upon humanity that did not previously exist (Gen.
3:1-24). God is self-revelatory, and as a way to heal this rupture, invites
humanity to enter a covenant relationship. This covenant is an offer
from God of a life-giving relationship. The archetype for this is God's
call to Abraham (Gen. 12; 15:18-21). In the Jewish tradition, the priests
were the interpreters of the Law, the mediators between God and God's
chosen people. Infractions of the Law were disclosed, or confessed (Lev.
5:5; 16:20-24; 26:40-42).
As the people and their religious experience developed, their rela-
tionship with God deepened; there evolved a desire to remain on good
terms with God. This is reflected in the development of cultic religious
practices. Psalm 32 is evidence of this. This psalm is an individual
proclamation, probably recited in a ritual setting before a collected com-
munity of believers. In part, the psalmist states: "blest is he whose
transgression is forgiven ... when I declared not my sin, my body
wasted away ... I acknowledged my sin to thee and I did not hide my
iniquity ... then thou didst forgive the guilt of my sin." In the psalm God
replies, "I will instruct you and teach you the way you should go. I will
counsel you with my eye upon you." A more recent, and poetic transla-
tion (Sullivan, 1983) of the psalm ends with the line: "We tell You, all of
us You set free" (p. 32). The sense of freedom that results from self-
disclosure is clear.
In this psalm we see self-disclosure ritualized. While here it is
directly between God and the individual, the very practice of ritual
celebration brings others in as mediators (Lev. 16:20-24). It is only a
small step then to utilize other people as mediators of this "counsel."
Hence, it is possible to see these practices as precursors to the practice of
spiritual direction.
Rabbi Arthur Green, a prominent writer on Jewish spirituality,
notes both the rich history of the master-disciple relationship in Jewish
mystical spirituality, and the in-depth knowledge of religious psychol-
ogy of these masters. Unfortunately, there was a historical tendency to
refrain from speaking of one's personal experience with God. It was not
considered appropriate to do so publicly, and was only passed on in a
one-to-one basis, to a "pupil both wise and already intuitively open to
such matters" (1988, p. 8). Thus, there is a lack of "confessions," the
telling of one's personal spiritual experiences, in Jewish spiritual litera-
ture. Yet this is a heritage of the Jewish faith, and Green argues for
renewed interest and development of a richer faith experience by tap-
ping into the Jewish mystical and master-disciple traditions, which in-
volve disclosing and sharing of one's experiences with others.
Self-Disclosure in Religious Spiritual Direction 19

In the Christian tradition, these themes have been further devel-

oped, and the focus is on God's actual manifestation in Jesus Christ.
Jesus revealed himself as both God and a human being, inviting others
to a relationship with him (Matthew 11:28). There is a clear expression in
the Gospels of the master-disciple relationship between Jesus and his
followers (Luke 5:5; 9:49; Matthew 8:23). Indeed, in the Western tradi-
tion, the evolution of religious experience can be seen as an ever-
increasing disclosure of God to humankind, with a concomitant recip-
rocal disclosure of humanity to God. More often than not this dis-
closure is mediated by another human being. Indeed, Jesus, as God and
human being, is the primary source of this disclosure and mediation.
This is not primarily the case in the Eastern tradition, where there is
an emphasis on impersonality. Buddhist traditions are centered on
meditative practices to help an individual become one with the void.
The master-disciple relationship is central to the process, but according
to Acharya (1982), this relationship is not comparable to the place spiri-
tual sonship has in the Christian tradition. The end result is not toward
union with God, but toward emptiness (see McDargh's (1984) discus-
sion for a comparison and contrast of Christian and Eastern religious
experience ).

Conditions for Self-Disclosure

For the present discussion, self-disclosure should be seen as a pro-
cess, i.e., a means toward an end. Self-disclosure is a means toward the
development of some type of intimacy. There are two important ele-
ments, two necessary preconditions, before self-disclosure can take
place. The first condition is a relationship. The second is trust.
Self-disclosure cannot happen without a relationship. It may seem
unnecessary to state the obvious, but I do this for two reasons. One is to
call to mind the essential relatedness of humanity, one to another, and
that the quality of these relationships will determine whether authentic
self-disclosure will take place. The other reason is that it is important to
remember that in religious experience, particularly in Western tradi-
tions, relationships are essential. Even in the case of hermits, there is
usually an extended period of community living. For example, the Rule
of St. Benedict, a rule for living the monastic life, holds that only after
living with others in the monastery for a long time may the monk seek
the solitary way of life. The monk is prepared for this by the "help and
guidance of many" (RB 1:3-5; Fry, 1981). During this period, the future
hermit is generally under the tutelage of an experienced spiritual guide.
It is after such a relational experience that one takes up the life of a
hermit as a means to develop a more intense relationship with God.
20 Bede J. Healey

Further, relationships can provide multiple levels of meaning. Of-

ten, relationships with others are the vehicle for experiencing and un-
derstanding one's relationship with God. In the Jewish tradition,
prophets and priests were the mediators of God's will and way to His
people. In the later Hassidic tradition the spiritual master is also defined
in terms of a relationship. In discussing this point, Rabbi Arthur Green
states, "It's not that he [the master] knows the esoteric Torah that nobody
else knows, but he knows this disciple's Torah, because he knows this
discipline so well and stands in relationship to him" (Ware, 1974, p. 314).
In the Christian tradition, the relationship of Son and Father is
given central prominence (Matthew 5:45; 5:48; 10:21; 10:31), and this is
taken up in full force by the desert fathers and mothers of the fourth and
fifth centuries. Regarding relationships, it is important to note that es-
pecially in the Christian tradition, spiritual direction is not a dyadic
relationship. It is triadic; God is always present as the third person, "for
where two or three come together in my name, there am I with them"
(Matthew 18:20). This has special implications for self-disclosure in the
Christian tradition. Again and again in the literature on spiritual direc-
tion, the presence of God is emphasized, and the role of the director is
described as one of facilitating the directee's relationship with God.
Indeed, the notion of a dyadic versus a triadic relationship is a primary
distinction between therapy and spiritual direction.
In addition, it is important to note the collective, communal nature
of religion and religious experience. The relationship with God is both
individual and communal, and one self-discloses both as an individual,
and as a member of a community. There are ritual self-disclosing prac-
tices of both an individual and a communal nature in almost all Judeo-
Christian religions. These include the Yom Kippur services and attendant
practices in the Jewish faith, and the confession and penance celebra-
tions, as well as the practice of spiritual direction, in the Christian
traditions. Communal rituals help promote identity and solidarity. They
also help promote the acceptance of the basic human condition, de-
scribed by various authors as being weak, wounded, in need of help,
and incomplete.
The second necessary condition for self-disclosure flows from the
first, the need for trust. Without a sense of acceptance by another per-
son and trust in that person's ability and desire to be with oneself,
authentic self-disclosure will not take place. While trust is basic to the
development of a relationship, other elements are also necessary. Wit-
ness what some people say are the necessary prerequisites of someone
who aspires to be a spiritual director:
"Have a loving patience."
"Be a fellow searcher."
Self-Disclosure in Religious Spiritual Direction 21

hospitality; openness; an ability to welcome all of life."

/I • • •

"Have an applied knowledge of both psychological and spiri-

tual areas."
"Be in full communion with the whole of your humanity./I
" ... provide an environment out of which a person can pay attention
and allow this intuitive noticing to become an important part of his/her
life" (Edwards, 1980, p. 127).

Self-Disclosure in Religion and Psychotherapy

Broadly speaking, psychotherapy is concerned with the growth
and development of the individual to enable him or her to live more
freely, unencumbered by the myriad maladaptive patterns that tend to
restrict, confine, and limit one's potential. In the psychotherapeutic pro-
cess, self-disclosure promotes intimacy, which allows therapy to proceed.
As a religious practice, self-disclosure ultimately promotes intimacy
with (or a clearer vision of) God. This intimacy is mediated in most cases
by others, although there are strong mystical traditions in all religions
that attest that God's presence can be directly experienced. An addi-
tional point is that this process of developing a closer relationship with
God is often concomitant with (some might say preceded by) a deeper
understanding of oneself. It is at this level that parallels between reli-
gious experience and psychotherapy become clearer.
Lonsdale (1985) has listed some of the different ways Christians
have conceived of the director in spiritual direction: guide, companion,
/I

soul friend, spiritual father or mother, fellow pilgrim, 'God's usher,'

'artist of ongoing faith' " (p. 94). The master-disciple and guru-disciple
models appear to be less popular outside of monastic and Eastern tradi-
tions (although, in the monastic tradition, ther~ is also a strong influ-
ence of motherhood/fatherhood, and this will be elaborated below), yet,
as Lonsdale points out, early dependence can lead to a mature freedom
if this is carefully handled. In all of these models, being with, and
disclosing to, another are essential to the process of spiritual direction.
Schneiders (1984), and Connolly (1975) highlight an interesting
trend in present-day spiritual direction, that of an experiential approach
to both understanding and transmitting the essentials of this field.
Schneiders makes the point that by speaking about and focusing on the
present experience in the process of spiritual direction, this anchors the
practice in the present cultural milieu. I would add that it also accentu-
ates the relationship, and ultimately, the self-disclosing aspect of spiri-
tual direction. A weakness of this approach is a lack of interest in,
or knowledge of the long history of the many traditions of spiritual
direction.
22 Bede J. Healey

How Spiritual Direction Differs from Psychotherapy

What is spiritual direction, and how does it differ from psycho-
therapy? Indeed, there is considerable overlap, and a number of authors
have written on this subject (Walsh, 1976; Doran, 1979). Many writers
believe it is important to separate one from the other. McCarty (1976)
believes that it is important to differentiate spiritual direction from psy-
chotherapy so as not to trivialize either. Geromel (1977) compares and
contrasts therapy and spiritual direction, using Yalom's (1975) concep-
tualizations as a starting point. In his article, Geromel states that the
difference is in intent and focus, and that this difference transcends
methodology. Leech (1977) devotes an entire chapter to exploring the
relationship among spiritual direction, counseling, and psychotherapy.
His extended discussion precludes a simple statement outlining the
differences of each; for Leech, there is no easy dividing point between
what is spiritual and what is psychological. There is significant overlap
between these areas. Leech points out the many parallels between the
various practices of spiritual direction throughout the ages, and the
different psychotherapeutic techniques. The parallels are noteworthy
in that, at least in some respects, the two areas are more alike than
different.
Barry and Connolly (1982) state that spiritual direction "is con-
cerned with helping a person directly with his or her relationship with
God" (p. 5). Dyckman and Carroll (1981) define spiritual direction as "an
interpersonal relationship in which one person assists others to reflect
on their own experience in light of who they are called to become in
fidelity to the Gospel" (p. 20). The process involves objectification and
articulation of experience, as well as discernment, seeking to know
God's will for a person by interpretation of hislher experience in the light
of faith. Objectification and articulation are processes that may be used
in psychotherapy and counseling, while discernment is principally re-
stricted to spiritual direction. Self-disclosure is the ground from which
objectification and articulation can take place.
Connolly (1975) points out the function of attitude change that is
operative in both spiritual direction and therapy. This attitude change
leads to problem solving. Spiritual direction and therapy both deal with
development and require a trusting relationship. The difference be-
tween the two, Connolly believes, lies in who or what is responsible for
the positive changes that take place. "In counseling, insight, healing,
and new directions result basically from the relationship between coun-
selor and client. In direction they result basically from the directee's
relationship with the Lord" (p. 119). Integrity and freedom are important
to both relationships. In spiritual direction these are to be developed
Self-Disclosure in Religious Spiritual Direction 23

between the director and the directee, but the director is primarily a
facilitator of the primary relationship, that of God and the directee.
May (1982) points out that there have been periods when "psycho-
logical phenomena were seen in only spiritual terms," and then another,
more recent period where "spirituality was often seen in psychological
terms" (p. 4). He differentiates the two in terms of content and intent.
Regarding content, psychotherapy focuses on the emotional and mental
processes. Spiritual direction focuses on prayer, the relationship with
God, and religious experiences. The intent of psychotherapy, according
to May, is to encourage more efficient living, and to achieve a sense of
self-mastery both over oneself and one's life circumstances. Spiritual
direction's intent is to foster a sense of freedom from attachments and a
surrender to God and God's will. An attachment can be anything in a
person's life that clouds his or her vision and sense of God's will. As a
person becomes less concerned with nonessentials, that person will be
able to attend to what is essential, a deeper understanding of what that
person believes to be God's will for him or her.
None of the other attempts at differentiation seem as useful and as
clear as May's distinction of content and intent. The benefit of this ap-
proach toward distinguishing psychotherapy from spiritual direction is
that one can consider the tools as not belonging to either, but being
common to both. This is consonant with Leech's notion of the simi-
larities between the two approaches mentioned previously.

Self-Disclosure in Spiritual Direction

What is the nature of spiritual direction, and in particular, what is
the role of self-disclosure in the process? McCarty (1976) provides a
framework for understanding the purpose of self-disclosure in spiritual
direction. It is to help the individual keep honest in his or her search, to
work continually at the process of unmasking, striving for inner free-
dom and openhandedness in one's relationship with God. Again, the
process is similar to therapy, but the intent and final purpose are differ-
ent. The honesty is greatly facilitated by authentic self-disclosure.
Thomas Merton (1960), a Cistercian monk of our day, has this to say
regarding the experience of spiritual direction:
What we need to do is bring the director into contact with our real self, as
best we can, and not fear to let him see what is false in our false self. Now this
right way implies a relaxed, humble attitude in which we let go of ourselves,
and renounce our unconscious efforts to maintain a facade. (p. 24)

Certainly Merton, even though he does not use the word, places
great emphasis on the importance of self-disclosure. This is nothing
24 Bede J. Healey

new or unique to Merton. Nemeck and Coombs (1985), in their discus-

sion of the topic, provide quotations of similar sayings, including that of
St. John Climacus, a seventh century ascetical writer: "Lay bare your
wound to your spiritual physician. Without being ashamed say: 'Here is
my fault, Father. Here is my illness' " (p. 67), and of St. Basil, a fourth
century monk, who admonishes one of his followers to "reveal the se-
crets of his heart. .. By practicing such openness, we shall gradually be
made perfect" (p. 68). Self-disclosure, then, can be seen to be the cor-
nerstone and foundation of the practice of spiritual direction. These
writers, some of whom lived hundreds of years before our time, were
well aware of the difficulty in self-disclosing and the reluctance to speak
freely, thus the exhortations to lay bare the heart. The sayings of the
Desert Fathers, a collection of stories from desert monks who lived in the
first few centuries of the Common Era, reveal this as well.

The Desert Fathers

As mentioned previously, the original relationship between God
and humanity and the Judeo-Christian tradition was filial. The monks
of the desert, in the fourth and fifth centuries, developed the theme of
spiritual fatherhood and motherhood to the fullest. This tradition is still
strong in many current monastic communities, although present-day
spiritual direction in other areas generally is less focused on the father/
son, mother/daughter relationship. Yet, some understanding of this pe-
riod will shed light on the development of spiritual direction, and on the
essential nature of self-disclosure in this process.
Ward (1975) states that the relationship between a spiritual father, or
'abba,' and his son was 'vital,' that is, life-giving. The son would ap-
proach the father and ask for a 'word.' This word "was not a theological
explanation, nor was it 'counseling,' ... it was a word that was part of a
relationship, a word which would give life to the disciple if it were
received" (p. xxii).
Essential to the relationship was authentic self-disclosure. There is
the story of a brother who had difficulties in revealing his troubling
thoughts to his abba. His abba, guessing this, continued to encourage
the brother and give him advice. The brother was able to talk of his
problems and receive help (Louf, 1982). This practice was not primarily
the confession of sins, but the exploration of those deeply lurking
thoughts usually told to no one. Abba Poemen sees this as important,
and puts it succinctly (Louf, 1982):
Does he who knows he is losing his soul need to inquire? Hidden thoughts
are to be questioned, and it is the elder's task to test them; as for visible flaws,
there is no need to inquire, but to remove them right away. (p. 46)
Self-Disclosure in Religious Spiritual Direction 25

One can see the similarity here between this statement and the
belief in psychoanalytic theory that it is often the offhand comments or
seemingly innocuous thoughts that can have the most meaning.
Merton (1968), in summarizing the value of understanding the De-
sert tradition for present-day spiritual direction, states:
The Master does not merely lecture or instruct. He has to know and analyze
the inmost thoughts of the disciple. The most important part of direction is
the openness with which the disciple manifests to the spiritual Father not
only all his acts, but all his thoughts. (p.17)

To make his point Merton then quotes St. Anthony: "The monk
must make known to the elders every step he takes and every drop of
water he drinks in his cell, to see if he is not doing wrong" (p. 17).
The totality of self-disclosure is thus emphasized.

Self-Disclosure in Practice

What is this experience of self-disclosing and receiving spiritual

direction like? Wilson (1982) describes his experience as a spiritual son.
He emphasizes the necessity for trust in one's spiritual father. Wilson
makes the case that the self in the fledgling initiate to religious life is
undeveloped, and that at first, the son turns himself over to the father,
whose self is more fully developed. He states, "Left to his many desires,
often conflicting and sometimes totally destructive, the confused self of
the young disciple would often follow wrong and hurtful impulses. So
he chooses to follow the directives of the more achieved self of the
spiritual father" (p. 229). Implicit in this is the necessity of disclosing to
the spiritual father these "many desires." Thus, self-disclosure leads to
reflective understanding, and further growth in the development of the
true self of which Merton speaks. It is important to keep in mind that the
use of the word 'self' does not necessarily have a specific meaning, such
as is found in the writings of Kohut. Wilson, in particular, provides no
particular theoretical base for his understanding of the experience of
spiritual sonship, but, in my reading, he takes a developmental ap-
proach, and there is a literalness to his use of the terms father and son.
Still, there is to be no imposition of the father's ideas upon the son, but
rather the father nurtures the growth of his son as if he were his (the
father's) true self. Wilson's wording is slightly ambiguous. He seems to
be making the point that, through the son's disclosing to the father, and
through their shared working to understand the meaning of these dis-
closed thoughts and desires, a deeper understanding of God and God's
will for the son will result.
26 Bede J. Healey

Conclusion
Self-disclosure is integral to the religious practice of spiritual direc-
tion, and is a common element in both direction and therapy. While
religion can claim historical precedence, psychotherapy has done much
recently to increase our understanding of the role and uses of self-
disclosure. My reading of the literature shows a willingness on the part
of religion to use (too willingly? see Kemp, 1985) psychotherapy's ad-
vances and apply them to the practice of spiritual direction. May (1982)
feels that a too-ready application of psychological principles closes one
off from the rich spiritual heritage of the Western spiritual tradition.
Psychotherapy, on the other hand, has not been as willing to carefully
consider the role of self-disclosure in spiritual direction as developed in
religious circles. Again, for hundreds of years, the religious tradition
provided for both an individual's psychological and spiritual needs. A
careful look at the accumulated wisdom of the centuries could prove
helpful to the practice of psychotherapy.
McNamara, for example, believes the Christian tradition is funda-
mentally oriented toward individuation, and provides an outline for the
process, which eventually leads to wholeness of both the individual and
society. Perhaps overstating the point, McNamara (1975) writes:
The early Christian diagnosis of man makes Freud's comparable attempt
seem like a very weak cup of tea indeed. The discoveries of analytical psy-
chology do little else than repeat, in modern phraseology, and with detailed
empirical evidence, the principle injunctions of the Christian way. (pp. 404-405)

Geromel (1977) offers a similar view:

... 1 felt that the insights of psychotherapy would provide "new" material for
spiritual direction. This is obviously not the case. Much of our "new" in-
sights have been known for centuries .... It is, I believe, one of the "heresies"
of our time to believe that we are the discoverers of new information, and that
what went before does not relate to the present. (p. 763)

It has only been recently that there has been a revival of interest in
the rich traditions of the religious and spiritual past. Perhaps, as the
ideas and sources become more readily available, further exploration of
the psychological principles developed over the centuries by the various
spiritual traditions will take place.

References
Acharya, E (1982). The guru: The spiritual father in the Hindu tradition. In J.R. Sommer-
feldt (Ed.), Abba: Guides to wholeness and holiness East and West. Kalamazoo, Mich:
Cistercian Publications.
Self-Disclosure in Religious Spiritual Direction 27

Barry, w.A., & Connolly, W.J. (1982). The practice of spiritual direction. New York: Seabury
Press.
Callahan, A. (1988). Traditions of spiritual guidance: Thomas Merton as spiritual guide.
The Way, 28, 164-175.
Connolly, W.J. (1975). Contemporary spiritual direction: Scope and principles, an intro-
ductoryessay. Studies in the Spirituality of Jesuits, 7, 95-124.
Doran, R.M. (1979). Jungian psychology and Christian spirituality: 1. Review for Religious,
38, 497-510.
Dyckman, K.M., & Carroll, L.P. (1981). Inviting the mystic, supporting the prophet. New York:
Paulist Press.
Edwards, T. (1980). Spiritual friend. New York: Paulist Press.
Fry, T. (Ed) (1981). RB 1980: The Rule of Saint Benedict. Collegeville, Minn: Liturgical Press.
Geromel, E. (1977). Depth psychotherapy and spiritual direction. Review for Religious, 36,
753-763.
Green, A. (1988). Rethinking theology: Language, experience, and reality. Reconstruction-
ist, 54, (Sept.), 8-13,30.
Kemp, H.Y. (1985). Psychotherapy as a religious process: A historical heritage. In E.M.
Stern (Ed.), Psychotherapy and the religiously committed patient. New York: Haworth
Press.
Leech, K. (1977). Soul friend: The practice of Christian spirituality. San Francisco: Harper &
Row.
Lonsdale, D. (1985). Bookshelf. The Way Supplement, 54, 94-103.
Lou£, A. (1982). Spiritual fatherhood in the literature of the desert. In J.R. Sommerfeldt
(Ed.), Abba: Guides to wholeness and holiness East and West. Kalamazoo, Mich: Cistercian
Publications.
May, G. (1982). Care of mind, care of spirit. San Francisco: Harper & Row.
McCarty, S. (1976). On entering spiritual direction. Review for Religious, 35, 854-857.
McDargh, J. (1984). The life of the self in Christian spirituality and contemporary psycho-
analysis. Horizons, 11, 344-60.
McNamara, W. (1975). Psychology and the Christian mystical tradition. In C. Tart, (Ed.),
Transpersonal psychologies. New York: Harper & Row.
Merton, T. (1968). The spiritual father in desert tradition. Cistercian Studies, 3, 3-23.
Merton, T. (1960). Spiritual direction and meditation. Collegeville, Minn: Liturgical Press.
Nemeck, EK., & Coombs, M.T. (1985). The way of spiritual direction. Wilmington, Del:
Michael Glazier.
Schneiders, S.M. (1984). Horizons on spiritual direction. Horizons, 11, 100-112.
Sullivan, EP. (1983). Lyric psalms: Half a psalter. Washington DC: Pastoral Press.
Walsh, w.J. (1976). Reality therapy and spiritual direction. Review for Religious, 35, 372-385.
Ward, B. (1975). The sayings of the desert fathers. Kalamazoo, Mich: Cistercian Publications.
Ward, B. (1984). Spiritual direction in the desert fathers. The Way, 24, 61-69.
Ware, K. (1974). The spiritual father in Orthodox Christianity. Cross Currents, 24, 296--320.
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Yalom,1. (1975). The theory and practice of group psychotherapy. New York: Basic Books.
 II
Theoretical Perspectives
 3
Self-Disclosure and
Classical Psychoanalysis
Robert C. Lane and James W. Hull

The Problem of Self-Revelation

Fenichel (1945) pointed out the paradoxical nature of the patient's experi-
ence around self-disclosure, describing the wish to conceal as the es-
sence of resistance: the patient who has entered therapy to reveal
himself to the doctor in order to learn more about himself continually
acts out the wish to conceal. The issue of self-disclosure has been hardly
less problematic for the psychoanalytically oriented practitioner, leading
to a number of intense debates in the history of psychoanalysis.
These debates have revolved around questions such as the follow-
ing: Should the patient be the only member of the dyad to self-disclose,
or should the therapist also engage in self-revelation? Does personal
self-revelation make the therapist seem more humane, leading to
greater self-revelation on the patient's part (referred to by Jourard (1971)
as the "dyadic effect"), thereby enhancing therapeutic progress? How
much and what types of personal information should the therapist
share? Are there situations or types of patients for whom self-revelation
might have an opposite effect, setting back the therapy or even harming
the patient? Does therapist candor, authenticity, and openness mean the
same thing to all practitioners and all patients? How should the decision
around self-disclosure be influenced by variables such as the age and

Robert C. Lane • Institute of Advanced Psychological Studies, Adelphi University, Gar-

den City, New York 11530. James W. Hull • New York Hospital-Cornell Medical Cen-
ter, Westchester Division, 21 Bloomingdale Road, White Plains, New York 10605.

31
32 Robert C. Lane and James W. Hull

sex of the patient, and the stage of therapy? Other more technical ques-
tions, such as those regarding the nature, intensity, and timing of self-
revelation, also have been raised.
Currently there exits a strong polarization among therapists of dif-
ferent schools regarding these issues. Dissatisfaction with classical psy-
choanalysis has included the criticism that its practitioners, most of
whom eschew self-revelation, can be aloof, nonresponsive, and seem-
ingly unavailable. The various therapies of the human potential move-
ment (Murphy, 1958) have been one outgrowth of such criticism. Many
of these approaches advocate "therapist's transparency," a willingness
to share immediate impressions as well as past experience with the
patient. This is said to make the therapist more humane, to bind thera-
pist and patient together in an exchange of intimacies. The therapist
provides a model for personal growth, facilitating spontaneous, genu-
ine, and even "creative" being (Culbert, 1961; Trilling, 1975). Examples of
such approaches include humanistic/existential therapy, client-centered
therapy, sensitivity training and the encounter movement, experiential
therapy, gestalt therapy, bioenergetics, and some varieties of cognitive-
affective therapy.
Family therapists also have argued for the usefulness of self-
disclosure. Whitaker related success in family therapy mainly to the
therapist's self-involvement in the process, including the sharing of
unique personal reactions, confusion, and uncertainties (Whitaker &
Malone, 1953; Napier & Whitaker, 1978; Whitaker & Keith, 1981). He
argued that self-disclosure might be the only strategy that could rescue
a family treatment from impasse, but cautioned that it could produce
harmful effects for therapist and family alike. Others who have made
similar points include Garfield (1987) and Watzlawick (1978).
While these voices have echoed across the current professional
scene, many psychoanalysts have continued to advocate the neutrality
and anonymity of the "blank screen," feeling that self-revelation may
contaminate the transference and interfere with its resolution. Expres-
sions of the analyst's personal opinions, attitudes, and feelings still are
seen by many as a sign of countertransference difficulties. Texts on
psychoanalytic technique commonly espouse this position (e.g., Feni-
chel, 1945; Fine, 1982; Glover, 1955; Greenson, 1967; Langs, 1982; Men-
ninger, 1958; Strean, 1982). The psychoanalytic community has not been
unanimous in its rejection of self-revelation, however, and in recent
years some analysts have begun to explore how judicious self-disclosure
may further the work of analysis. This has led to a rediscovery of the
early writings of Ferenczi.
In the present chapter we discuss the problem of therapist self-
disclosure from the perspective of classical psychoanalysis, tracing the
Self-Disclosure and Classical Psychoanalysis 33

historical debate and current controversy around the benefits and costs
of such intervention. We will not take up the question of patient self-
disclosure, and also will limit ourselves to comments about indivi-
dual psychotherapy. Many new approaches advocating therapist self-
revelation have evolved from the group therapy field and in this sense
our comments may not be directly applicable to those modalities where
therapist self-disclosure is most common. Nevertheless, we feel that
psychoanalytic thinking about self-disclosure in the analytic relation-
ship highlights central issues and problems that can be applied usefully
to other therapeutic modalities.

Self-Disclosure and the Early Analysts

Freud (1915) felt that the patient needs a safe environment for per-
sonal self-disclosure, including reassurances that his or her communica-
tions will be confidential and no punishment will result from saying
whatever comes to mind. Thoughts, feelings, impulses, dreams, fanta-
sies, and traumatic memories are to be revealed to an objective, under-
standing, and empathic listener. In this way the power of the patient's
critical superego is reduced, fostering the emergence of unconscious
material. With the development of healthier ego controls the patient is
slowly freed from the debilitating anxiety that keeps him or her from
living more fully.
In his writings on technique Freud (1912) advocated a policy of
strict nondisclosure on the part of the analyst. The analyst should re-
main "opaque to his patients, like a mirror and show them nothing but
what is shown to him" (p. 118). In this paper, he also warned against too
much intimacy on the part of the doctor. Later (1919) he stated that, "the
patient must be left with unfulfilled wishes in abundance, deny(ing)
him precisely those satisfactions which he desires most intensely and
(has) expressed most importunately" (p. 164). Privation and frustration,
fostered in part by a non-revealing stance, are used to maintain the
patient's motivation for carrying on the work of analysis. "The patient's
need and longing should be allowed to persist. .. in order that they may
serve as a force impelling the patient to work and make changes"
(Freud, 1919, pp. 164-165).
Although his writings are clear in their recommendation for absti-
nence and neutrality on the analyst'S part, records of how Freud actu-
ally worked indicate his "sovereign readiness to disregard his own
rules" (Gay, 1988, p. 292). There was a personal and compassionate ele-
ment to his demeanor in the consulting room, which he felt to be unob-
jectionable, an aspect of the human relationship between patient and
34 Robert C. Lane and James W. Hull

doctor that is separate from the work of analysis. Gay (1988) provides
many examples of Freud's self-revelations and "non-neutral" behavior
with patients. For example, his analysis of Eitington, which was one of
the first training analyses, was conducted during leisurely strolls
around Vienna. At times Freud gave gifts to patients, and he was known
to remit fees when a patient fell on hard times. His decision to analyze
his daughter Anna directly contradicted earlier technical recommenda-
tions regarding neutrality and the need to function as a blank screen. He
assisted Max Graf in the analysis of his own young son (Little Hans),
and later when Jung began to analyze his wife Freud encouraged him,
thinking that he might meet with some success. The Rat Man was pro-
vided with a meal when he arrived for a session hungry, and other
solicitous behavior was directed toward Wortis (1954), Doolittle (1956),
Blanton (1971), and Kardiner (1977).
Freud's self-disclosure with patients finds its complement in his
writings for other professionals. In The Interpretation of Dreams (1900) he
reported and analyzed some of his own most revealing dreams, often
reporting highly embarrassing childhood memories which were uncov-
ered by his associates. For example, the discussion of the dream of
Count Thun includes memories of an incident when he was seven or
eight and urinated on the floor of his parents' bedroom, prompting his
father to predict he never would amount to anything. Gay (1988) also
describes how self-revelation and "wild analysis" were a regular part of
the culture and collegial interaction of the early analytic community.
While on the ship to America, Freud and Jones passed the time by
analyzing each other's dreams. Offhand interpretations of colleagues'
personalities, dreams, and slips of the tongue were common, with diag-
nosis of paranoia and homosexuality freely given. "They all practiced in
their circle the kind of wild analysis they decried in outsiders as tactless,
unscientific and counterproductive .... Freud played this game with the
rest" (Gay, 1988, p. 235).
Freud's abandonment of the seduction theory led him to emphasize
intrapsychic conflicts and minimize the role of the actual environment in
the causation of neurosis. By contrast, Ferenczi placed increasing em-
phasis on the role of real trauma in pathogenesis (Lum, 1988a,b). In his
clinical diary he maintained that psychoanalysis placed too great an
emphasis on the role of fantasy, and whenever analysis went deeply
enough a traumatic-hysterical basis of neurosis could be uncovered. He
drew a parallel between the child traumatized by the hypocrisy of
adults, the mental patient traumatized by the hypocrisy of society, and
the analysand whose trauma is revived by the technical rigidity of the
analyst. The analyst's hypocrisy consists of the denial of counter-
transference feelings, and it is this that reactivates the earliest traumas
of the patient.
Self-Disclosure and Classical Psychoanalysis 35

In order to deal with the reactivation of early traumas in analysis,

Ferenczi proposed a number of technical innovations that departed sig-
nificantly from the method outlined by Freud. He first experimented
with an "active technique," in which privation and absence of gratifica-
tion were carried to an extreme. He imposed restrictions on patients in
the areas of sex, food, drinking, and smoking in the hope of gaining
insight into the damming up of libido and releasing "inaccessible uncon-
scious material" (Lum, 1988a,b), but discovered this usually led to in-
creased anxiety, rage, and defiance (Thompson, 1964).
Ferenczi's later experiments focused on the development of a "relax-
ation technique." Abandoning the authoritarian and "cold" stance of the
classical analyst, as well as his earlier "active technique" of privation
and abstinence, Ferenczi transformed the analytic setting into one of
indulgence. Instead of functioning as a mirror, passively and at times
aloofly reflecting the patient's reactions, the analyst should adopt a
stance of warmth and participation. He must become a "good" loving
mother, empathic, involved, highly sensitive, and responsive to the pa-
tient's needs. The goal was removal of anxiety and a reliving and dis-
charge of feelings related to the original trauma experienced at the
hands of the parents. Of paramount importance were the analyst'S sin-
cerity, authenticity, and truthfulness, so that the original insincerity of
the parents would not be repeated. The analyst's real personality, his
ability and willingness to be a new and healthy parent, would help undo
the original childhood traumas.
In this search for truth the analyst must be willing to face himself,
giving free rein to self-criticism and accepting the possibility that the
patient's accusations have a reality basis. Ferenczi believed that the an-
alysand could accurately perceive the analyst's errors, resistances, and
blind spots. Responsibility for failure to make progress should not be
placed solely on the patient, but rather on the therapist-patient interac-
tion and the transference-countertransference exchange. The therapist
should admit his mistakes and say, "I'm sorry," but Ferenczi went even
further, advocating that the therapist "unmask his professional hypoc-
risy" by revealing his own secrets, resistances, annoyances, and short-
comings to the patient, making his disturbance fully conscious and
discussing it with the patient (Ludmer, 1988; Zaslow, 1988).
Reciprocity was carried to the point of having his patients analyze
him, termed "mutual analysis" (Dupont, 1988). In his diary Ferenczi
states that when an analyst is unable to help the patient because of his
own blind spots, he at least has the obligation to provide guideposts by
acquainting the patient with his own weaknesses and feelings. This
technique of mutual analysis was originally the idea of one of his
36 Robert C. Lane and James W. Hull

patients, a woman who had been in analysis for two years and whose
treatment was stalemated. Ferenczi first found this patient disagreeable
and in overcompensation had yielded to all her wishes. She came to
believe that he was in love with her and that she had found the ideal
lover. Frightened by this, he retreated, interpreting the negative emo-
tions she shouldbe feeling toward him. She responded with the same
interpretations directed toward him, which he felt were not unjustified.
He decided to express his feelings freely to her, and noted that she began
to make progress again in her sessions. Carrying the experiment fur-
ther, he scheduled double sessions or alternating sessions, one for her
and one for him.
Gradually Ferenczi became aware of the problems of mutual anal-
ysis, including the patient's wish to deflect attention from herself, the
impossibility of letting oneself be analyzed by every patient, the need to
respect patients' sensibilities, and the problem posed by the discretion
owed to other patients. He specified the limitations of mutual analysis:
it should be practiced strictly according to the needs of the patient, and
no further than necessary for the patient. Eventually he considered
letting himself be analyzed only after the patient's analysis was com-
pleted. When his patient began to develop delusional ideas about their
collaboration, suggesting they prolong it indefinitely and that without it
Ferenczi would lose his therapeutic skill, he terminated the experiment.
In reflecting on this experience he concluded that mutual analysis was
only a technique "of last resort," when the training analysis had been
incomplete.
Lum (1988a,b) documents Freud's strong disapproval of Ferenczi's
technical innovations. Freud felt that Ferenczi was obsessed, first with
the need to cure by extreme deprivation (active technique) and later with
the need to cure by love (relaxation technique). He chastised Ferenczi
particularly about rumors that he permitted kissing. The analytic com-
munityat the time reacted with amazement and extreme criticism. More
recent evaluations have been less condemning. Rachman (1988) points
out that in addition to challenging the classical position that the analyst
should be a "mirror," Ferenczi was the first dissident analyst to offer an
alternative to the Oedipus complex. Ferenczi was one of the first psycho-
analysts to call attention to the crucial importance of the earliest mother-
child relationship. In identifying early affect deprivation as one cause of
infant death, he predated Spitz' (1946) work on marasmus. Finally, in his
emphasis on the analyst as a human partner in the therapeutic ex-
change, with a focus on transference-countertransference dilemmas, he
paved the way for later interpersonal and self psychological pioneers
such as Sullivan, Fromm, and Kohut.
Self-Disclosure and Classical Psychoanalysis 37

Contemporary Views on Self-Disclosure

Ehrenberg (1984) has taken up the question of self-disclosure from
the perspective of the interpersonal analyst in her discussion of "direct
effective engagement." Arguing that expressing affective reactions to
the patient may "add a new dimension to analytic interaction," she
shows how the analyst's shared countertransference responses may
help patients become aware of their own repetition compulsions and
actual impact on others. "The transference-countertransference drama,
as it develops in the immediate relationship, (is a) ... window to the past,
as well as a prism or lens, not a barrier." Judicious use of counter-
transference also may help the patient see that the analyst has real
feelings, supporting the experience of empathy and understanding. It
encourages the patient to assume responsibility for his or her participa-
tion, or lack of it, in events both inside and outside the sessions. Ehren-
berg cautions that too much or too little affective participation on the
part of the analyst can destroy the relationship. Not responding affec-
tively can lead to a feeling of abandonment, transference/counter-
transference collusion, increased resistance, and detachment. For her
the important questions are: (1) When to react? (2) How much to share of
one's reaction? and (3) When would it be helpful to the patient, encour-
aging further exploration, and when would it be burdensome to have
such material shared?
In his discussion of Ehrenberg's paper, Spence (1984) agrees that the
important question is when is it useful and when is it a mistake to share
such responses, and to "what extent does a focus on the here and now
violate the assumption of the basic rule and put the patient unneces-
sarily at risk?" He stresses the need to clarify the concept of neutrality,
pointing out that its meaning might be very different for different pa-
tients. Breger (1984) also agrees it is crucial to clarify concepts such as
"neutrality," "abstinence," and "gratification," since each analytic con-
tact is different and must be understood on its own terms. He feels that
interventions in which the therapist communicates emotional reactions
of acceptance, empathy, and encouragement are especially potent. Uti-
lizing self-disclosure to help resolve a transference-countertransference
impasse is seen as an intervention "fraught with danger," and demand-
ing considerable experience; "such moments are not for the beginner."
Breger feels that communicating negative feelings directly to the patient
almost always is a mistake; "it is most often felt as criticism ... and a
betrayal of the very openness that one has encouraged ... "
Khan (1986) presents what is perhaps the most vivid example of
current analytic work in which self-disclosure is used to an extreme.
With his patient Khan violated many of the usual ground rules, so that
38 Robert C. Lane and James W. Hull

classical analysts would not consider this psychoanalysis at all. The

patient's outrageousness had first manifested itself when he farted dur-
ing his fifth birthday party. His mother was disgusted with him, both
for the farting and for the behavior that followed, including his refusal to
go out or go to school for weeks at a time. After her three-month hospi-
talization during which he was cared for by his grandparents, she re-
turned home to find him "filthy" and stated, "it took four months to
straighten him out." He withdrew, didn't participate in games, just
stayed in his room reading and gluing together pebbles that he had
collected. In later life this man perfected the art of quietly provoking
others. For example, he was spiteful with his employees, leaving out
crucial details in his instructions to them, so that they never knew what
had to be done.
Khan carried out two analyses with this patient, with a three-year
period intervening during which Khan fought a life-threatening battle
with cancer that required the removal of half his larynx and many
operations. When the patient began his second analysis, Khan shared
the details of this illness. He stated, "I no longer have the strength or
motivation of three years ago to devote energy and talent to someone
who wants to play games ... Thank you for coming ... I can refer you."
And later, "I have been fighting death for two years and more and have
made it back to the living and working ... but I was damaged in my
physique. Now I make the demands." In this way Khan conveyed that
he felt under no obligation to save the patient or be blackmailed by
suicidal threats.
Khan acted capriciously in an attempt to change the tempo and
"unsettle" this patient. He kept the patient waiting for some appoint-
ments, permitted him to leave one appointment after only 30 minutes
and kept him for over two hours during another. He demanded three
hours' notice if the patient was going to cancel his second session, a
number made up on the spot with no explanation given to the patient.
He said he was determined to conduct the analysis as if the patient were
five years old, and not be cowed by the patient's provocativeness. When
the patient brought up the subject of money, Khan let him know that he
was not intimidated by financial considerations, stating, "My father has
taken care that I should never need to earn money ... I don't need this, I
can go to my estates." When the patient challenged him by saying it was
little wonder that he was having trouble in the British Psychoanalytic
Society, Khan said he didn't give a damn, he was in demand all over the
world and even if he were not he could return to his family's ancestral
estates in Pakistan. He discussed his butler, chauffeur, and the staff of
his Pakistan estate with his patient.
In commenting on this case Khan describes the effective ego state of
Self-Disclosure and Classical Psychoanalysis 39

outrage and outrageousness as a distinct syndrome, related to the cu-

mulative trauma that can result from supposed "good-enough moth-
ering" (Khan, 1963). When the child is raised as a "cot baby," to be clean,
tidy, and good, but with an excess of inhibition and a restriction of
spontaneity, outrage, and outrageousness may result. The aggression of
such patients, often first manifested in adolescence, is not overt but is
turned into provocativeness and devious spitefulness. Such "pretend
care" also leads to a considerable amount of unrelatedness, particularly
in later life. Kahn feels that clinical handling is difficult "because inter-
pretation is an alibi the analyst uses to cover his incapacity to deal with the
patient's conduct. The patient knows how to exploit the analyst'S tech-
nique to his advantage, with compliance, without reaching that authen-
ticity which is his personal self." In dealing with such patients Khan is
himself ready to act out in an "interpretative" manner. "When the pa-
tient needs me to hold him by acting (managing his private life) I act."
The major current spokesman for a traditional stance of restraint
with regard to self-disclosure is Langs (1982). He spells out necessary
conditions for an ideal therapeutic framework, the "definitive rules of
relatedness" through which a healthy therapeutic symbiosis may be
constituted and maintained. Practitioners are divided into those who
"adhere to all fundamental tenets," or move as close as possible to the
ideal therapeutic situation, and those who "modify one or another of the
basic ground rules ... (thus creating) ... a deviant treatment setting."
Breaks in the frame and a lack of adherence to these ground rules lead to
pathological forms of relatedness. Langs feels that such deviations "vir-
tually always" serve as "inappropriately seductive element(s)" that may
evoke powerful unconsci.ous sexual and aggressive dynamics. They
function as "powerful adaptation-evoking" therapeutic contexts to
which patients respond through "derivative communications" that the
therapist may easily misunderstand.
The basic ground rules include the therapist's neutrality and ano-
nymity, and the need for total privacy and confidentiality of the treat-
ment process. Neutrality, which insures the patient's safety, means
confining one's interventions to silences, interpretations, reconstruc-
tions, and the establishment and management of the ground rules or
framework. Interventions such as questions, clarifications, and confron-
tations, proposed as a means of fostering patient openness, are lacking
in neutrality and interfere with the patient's free association. Personal
opinions, self-revelations, directives, and unnecessary reassurances are
to be especially avoided. While these may provide momentary relief,
they always have a pathological effect and provide the basis for "thera-
peutic misalliances."
According to Langs, anonymity provides full opportunity for pro-
40 Robert C. Lane and James W. Hull

jection by the patient and lends a sense of safety to the therapeutic

relationship. It signals the therapist's willingness to forgo and renounce
pathological needs and repel any tendencies to misuse the relationship
for pathological satisfaction. Total anonymity is impossible and absurd,
but the therapist should not be deterred from striving for relative ano-
nymity, with self-revelations confined to those implicit in the setting.
Patients should be accepted for treatment only when there has been no
prior contact, so that relative anonymity has not been compromised.
Magazines, artwork, books, and furnishings in the therapist's office, as
well as the therapist's own personal appearance, should be minimally
self-revealing. Seeing the patient in a home office, revealing aspects of
one's personal life such as vacation plans, political preferences, or hob-
bies and interests, or disclosure of information about the therapist's state
of health or the reason for sudden cancellations are to be avoided. Langs
feels that self-revelations exist on a continuum, anchored at one end by
those "that are inevitable, humanly necessary, and do not interfere with
the therapeutic relationship" and at the other end by "a multiplicity of
deliberate self-revelations that clearly disturb the ideal therapeutic
environment and the relationship between the patient and therapist."
Most self-revelations, both deliberate and inadvertent, fall between
these two extremes.
Other contemporary analytic writers have taken a conservative,
although somewhat less rigid, position on the issue of self-revelation.
Anna Freud (1954) stated, "I feel still that we should leave room some-
where for the realization that the analyst and patient are also two real
people, of equal adult status, in a real personal relationship to each
other ... " (p. 618). Gitelson (1952) emphasized that an impasse may de-
velop if the analyst does not understand or avoids the patient's discovery
of him as a real person. Greenson (1967) saw the nontransference or real
relationship as an essential part of the working alliance "which makes it
possible for the patient to work purposefully in the analytic situation"
(p. 46), despite transference impulses. He recommends self-disclosure
around errors in technique, but stresses the need to analyze the patient's
reactions to mistakes and the analyst'S discussion of them. Weiner (1972)
outlined situations where self-disclosure is contraindicated, including a
poor therapeutic alliance and a state of negative transference. He stated,
"If a patient has some need to see me as a real person with whom a real
relationship can be established, such as an adolescent or an adult with a
borderline personality, I will often accede to his wish for historical infor-
mation" (p. 48). Even then, however, Weiner (1969) felt the therapist
should eschew total exposure, having an obligation both to himself and
his patients to offer professional competence rather than personal
idiosyncrasies.
Self-Disclosure and Classical Psychoanalysis 41

Special Events
Some events during psychotherapy by their very nature lead to
therapist self-disclosure. Examples are serious illness in the analyst,
pregnancy and birth, and marriage. Most of the literature to date has
dealt with illnesses in the analyst. Rosner (1986) identifies this as one
situation where self-disclosure may be necessary for the patient's emo-
tional health. To regard serious illness as no different than separations
due to vacation or minor illness represents denial on the part of the
analyst. Not revealing information gives the patient's fantasies free rein,
there is no opportunity to deal with distortions, and the failure to reveal
information, especially when it can provide relief, and runs the risk of
introducing real issues of exclusion, abandonment, and rejection. On
the other hand, divulging information prevents the emergence of trans-
ference distortions and may greatly complicate the patient's working
through of hostility toward the analyst. Crucial technical questions in-
clude: Who should inform the patient that sessions are to be cancelled?
How much factual information should be provided? Should different
patients be provided with different amounts of information, based on
their personality and the stage of their analysis?
With regard to the patient's reactions to the analyst's illness, Dew-
ald (1982) identified the problem as "the need adequately to explore the
full gamut of the patient's responses, affects and associations to the
illness, and to do this in the face of countertransference temptations
either defensively to promote premature closure and evasion of more
threatening affects, or to use the experience for exhibitionistic, mas-
ochistic, narcissistic or other neurotic satisfaction" (p. 361). He argued
that too much information may inhibit the patient's fantasies and reac-
tions, thereby interfering with the analysis, while too little information
may overburden the patient's adaptive capacity. He attempted to vary
his approach to the needs of each patient and the phase of therapy: some
factual material was offered to those in the beginning phase so that they
would not drop out, while the least factual information was provided to
those in the middle phase. He felt that patients in the terminal phase
"didn't need information."
Abend (1982) maintained that how much factual information is of-
fered should depend on how well the patient can maintain analytic
productivity "in the absence of factual information." He feels that most
analysts who have written on this topic have arrived at a solution close
to Dewald's, but cautions analysts to be aware of their own unconscious
needs that may be served by the transmission of factual information
about illness, even when it seems technically correct to provide such
information and the subsequent analytic work appears unimpeded or
even enhanced by the disclosure.
42 Robert C. Lane and James W. Hull

Another event that leads inevitably to self-disclosure is pregnancy.

Lax (1969) described pregnancy as " ... a personal event in the life of the
analyst that cannot be hidden from the patient and intrudes into the
analytic situation. The so-called anonymity and neutrality of the an-
alyst is interfered with" (p. 363). She related experiences with several
patients during her own pregnancy to illustrate that each responded
with a reactivation of those infantile conflicts most relevant to his or her
pathology. Fear of sibling rivalry and concerns about femininity are
especially likely to be aroused in the analyst. Lax concluded that preg-
nancy did "not necessarily interfere with the unfolding of a pattern of
infantile conflicts characteristic for a given patient" (p. 372). Paluszny
and Poznanski (1971) point out the wide variation in patients' reactions
to the analyst's pregnancy. Benedek (1973) discussed the reactions of
staff in a residential treatment center to the analyst's pregnancy.
Several writers have addressed the topic of "extra-analytic contacts"
when patients suddenly meet the analyst outside the session and learn
something about his or her private life. Tarnower (1966) delineated con-
flicting motives and wishes that such events can mobilize. Weiss (1975)
stressed the importance of analyzing these contacts in order to avoid
disruptive transference effects. He feels that when understood and in-
terpreted properly, especially with good timing, these occurrences can
be helpful in mobilizing, highlighting, and clarifying transference phe-
nomena. Katz (1978), writing of his experiences with patients after they
had seen him in a community play, also felt that transference and resis-
tance could be managed in such contacts. Strean (1981) delineated three
types of extra-analytic contact: those actively brought about by the pa-
tient, accidental contacts, and contacts anticipated by the analyst but not
by the patient. He argues that extra-analytic contact can interfere with or
heighten latent transference, countertransference, and resistance, as well
as "serve(ing) as an index of therapeutic progress." Such meetings are
interpersonal events "not to be encouraged or discouraged but thoroughly
analyzed." In discussing this paper Green (1982) feels it is erroneous to
believe such events may be disregarded as long as they are analyzed.
His position is close to that of Langs (1976), who stated that extra-
analytic contact always modifies the transference, offers neurotic grati-
fications, reinforces resistances, and undermines basic therapeutic work.

Discussion
Psychoanalysts have concerned themselves with the problem of
self-revelation since the earliest days of Freud. Self-disclosure was a
regular part of Freud's demeanor in the consulting room, and in their
Self-Disclosure and Classical Psychoanalysis 43

early congresses and informal social gatherings. Analysts revealed

much about themselves, sometimes too much, making self-disclosure a
regular feature of their informal professional culture. In addition, many
early writers followed Freud's example of using partially disguised self-
revelation to illustrate theoretical points, and from the beginning there
were bold experiments in technique such as those of Ferenczi.
Our own position on this issue might be described as one of "tem-
pered" restraint. We agree that the best environment for therapy is pro-
vided when the analyst assumes a neutral stance, when physical and
social contact are avoided, and the analyst's own conflicts do not intrude
into the patient's hour. The revelation of personal feelings, the telling of
anecdotes, and other forms of self-disclosure, usually hinder the thera-
peutic process. We feel that a willingness to share one's past or present
experience with the patient does not make the analyst more genuine or
humane, neither "unshackling" the patient nor providing a model for
spontaneous relating. It is naive to believe that self-disclosure will bind
analyst and patient together in "an exchange of intimacies."
On the other hand, we describe our position as one of "tempered"
restraint because some self-revelation always is present in analysis, and
that in certain special circumstances judicious self-revelation may fur-
ther the work of analysis. To try to eliminate self-disclosure completely
strikes us as unrealistic and probably undesirable. Langs has pointed
out that complete anonymity is impossible, suggesting instead that the
therapist strive for "relative anonymity." We do not go as far as Langs in
giving prescriptions regarding pictures on the desk, paintings on the
wall, or clothing that the therapist wears. Close approximations to com-
plete anonymity run the risk of moving the analytic encounter away
from its origins in, and ultimate impact on, everyday human experience.
As Anna Freud and others have pointed out, the patient's discovery of
the analyst as a real person may be a crucial phase of every analysis that
is carried toward completion.
Regarding "affective engagement," it seems to us that it should be
used very sparingly, and not until the analyst is quite clear about what is
going on in the transference. As Breger (1986) stated, such moments are
"not for beginners," and the use of countertransference to resolve thera-
peutic impasses can be very dangerous. Interventions of this type
should be intentional and planned with a clear rationale. For example, in
certain situations of crisis innocuous self-disclosure of related experi-
ence by the analyst may convey an element of relatedness, empathy, and
hope to the patient. Freud provides examples of this type of interven-
tion, such as sharing the details of his granddaughter's death in re-
sponse to Hilda Doolittle's attempt to work through the death of a loved
one (Gay, 1988). We recognize, however, that many classical analysts
would object to such technique.
44 Robert C. Lane and James W. Hull

In summary, we accept that much of the analyst's personality inev-

itably is revealed despite his or her best intentions, and feel that some-
times limited and judicious self-disclosure may further the work of
analysis. Self-disclosure by the analyst should be regarded as one as-
pect, perhaps even a central dimension of the ongoing analytic encoun-
ter, to be monitored and studied in the same way that the analyst studies
the ebb and flow of transference, countertransference, and resistance.

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46 Robert C. Lane and James W. Hull

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 4
Show and Tell
REFLECTIONS ON THE ANALYST'S SELF-DISCLOSURE

Sabert Basescu

The classical analytic stance has been that of the blank screen, with the
analyst maintaining anonymity. This article discusses the conceptual
bases for this position and how these conceptual issues are undergoing
modification. These changes impact upon the role of analytic anonymity
and consequently upon the nature of the analyst'S self-disclosure. The
article focuses on the writer's personal experience with self-disclosure in
the context of therapeutic work.

The public's image of the typical psychoanalyst has been given

expression in many jokes and satirical comments such as "He always
answers a question with a question," or "I knew he was alive because I
could hear him breathing." That image has been consistent with the
classical analytic role of the blank screen who discloses no personal
facts, reveals no emotions, but simply mirrors the projections of the
patient. My intention in this presentation is briefly to discuss the con-
ceptual issues that have sustained this analytic stance and how our
understanding of those issues is changing, the impact of these changes
on the concept of analytic anonymity and, finally, the nature of the
analyst's self-disclosure-especially my own.
Although Freud, the clinician, grossly violated most of the thera-

Sabert Basescu • Department of Psychology, New York University, New York, New York
10003, and the Westchester Center for the Study of Psychoanalysis and Psychotherapy, 516
Hommocks Road, Larchmont, New York 10538. Versions of this paper were presented at
The Manhattan Institute for Psychoanalysis on November 20, 1987, and at the NYU
Postdoctoral Program for Psychoanalysis on February 5,1988.

47
48 Sabert Basescu

peutic dictates of Freud, the meta psychologist, it is Freud, the theorist,

unfortunately, who has been the source of most of the structure of clinical
psychoanalysis. Freud, the theorist, made fantasy the primary focus of
psychoanalytic inquiry. Fantasy in this sense is not simply the imagined
elaboration of experience, but rather the symbolic reflection of intra-
psychic processes, wishes, and defenses, and their distorting impact on
experience.
If fantasy is all-important and reality more or less irrelevant, it follows
that the less reality offered by the therapist, the freer play afforded to the
patient's fantasy. Increasingly, however, the question has been raised
whether the primary data of psychoanalysis are facts or fantasies. Do
intrapsychic symbolizations have a life of their own or are fantasies a
function of the person's reality experiences? As Levenson (1981) puts it,
"Who dreams the dream? Does the dream perhaps dream the
dreamer?" (p. 486). Interpersonalists answer the question one way and
Freudians the other. Although theoretical allegiance has been the main
basis for choosing one's answer, recent infant research may provide
some independent evidence. Daniel Stern (1985) writes: " ... infants
from the beginning mainly experience reality ... It is the actual shape of
interpersonal reality, specified by the interpersonal variants that really
exist, that help determine the developmental course. Coping operations
occur as reality-based adaptations" (p. 255).
Perhaps a more clinically cogent way of discussing the same issue is
in terms of the concept of transference. Is transference a one-person or
two-person affair? (Gilt 1984). Those who hold to the one-person model
see the patient's distorting perceptions of the analyst as coming whole
cloth from the patient's past experience as structure_d by his or her intra-
psychic dynamisms. The intruding realities of the analyst's person and
personality can serve only to obfuscate the portrait of the life to be
explained. Therefore, it behooves the analyst to do all in his or her power
to minimize them.
Those who hold to the two-person model see transference as inter-
actional. That is, transference is regarded as the patient's attempt to
arrive at a plausible understanding of the analytic relationship and is
more or less influenced by the analyst's behavior. The concern is less
with the patient's distortions and more with constriction in modes of
understanding. For exampk a patient said, "I was trying to read the
meaning of changes in your tone of voice last time when we were talking
about makeup appointments. It felt like you thought I was a pest." I
said, "You read correctly that something was going on with me, but it
had to do with my realizing I was uncertain as to when I wanted to make
the appointment." He said, "I'm glad you told me. It's so easy to feel
crazy-like adults aren't supposed to react to changes in the tone
of voice."
Show and Tell: Reflections on the Analyst's Self-Disclosure 49

According to Levenson (1981), "The interpersonal therapist must

grapple with the real matrix of events and personalities in which every
therapy is embedded. It is not a question of what the patient has pro-
jected 'onto' the therapist, but of really who the therapist is and what he
brings to the therapy encounter" (p. 492). I would modify that to read
that it is at least as much one as the other.
Psychoanalysis, as a nondirective discipline, has traditionally main-
tained the importance of the therapist's neutrality. The issue of neu-
trality is relevant here in that the means by which it has usually been
operationalized is therapist anonymity. By avoiding disclosure of values,
feelings, judgments, and personal experiences, the therapist is pre-
sumed to convey neutrality. This has always reminded me of the issue of
stimulus constancy in experimental psychology. Does stimulus cons-
tancy refer to properties of the stimulus or perceptions of the observer?
Assuming the value of neutrality, how is it best conveyed? Here is
an excerpt from a session. The patient, a well-trained and experienced
analyst, was speaking of her work and describing how she is plagued by
self-doubts-thoughts of not doing enough for her patients or not doing
something right. I said that I thought the problem was not so much the
self-doubting questions - we all have those - bu t the consequences.
"For you it's life and death, for me there'll be other chances."
In the following session she said she had a dream that night. "A nice
dream. I was dressing in a different style-a checked blouse, blue and
aqua, more comfortable and stylish. It made me very happy. It was such
a happy dream. I was dressing more like women I admire-effortlessly. I
just found things in my closet and realized they could go together. It was
a color I like but never wear. I tend to wear somber tones. I don't like to-
I'm ambivalent about calling attention to myself." She spontaneously
went on to say, "I feel the dream is related to the last session. It was
relieving when you said last time that for you the consequences aren't
dire. You said something about yourself. That's meaningful to me. I feel
you care about me. For me, anonymity of my therapist duplicates my
background with my parents. I never knew anything about my parents'
experience of themselves. I remember being thrilled once that my
mother colored in my coloring book. I have only one or two memories of
my father revealing something about himself. Your anonymity is not
background but a constant stimulus. It's not freeing. It's provocative."
Whatever the other messages conveyed in this, one seems to be that
if I show my true colors, she feels freer to show hers. This is consistent
with ]ourard's (1971) research findings that the best way to foster self-
disclosure is to model it: " ... Intimate self-disclosure begets intimate
self-disclosure" (p. 17). Greenberg (1986) makes the point that personal
revelations may enhance or detract from neutrality. There is no fixed
50 Sabert Basescu

relationship between the two. He goes on " ... the analyst who main-
tains a posture of aloofness-that is, the analyst who has confused the
behavior of anonymity with the goal of neutrality-offers the patient no
context within which to appreciate the nature of his transference" (p.
85).
But there is even a further question as to the desirability of the
neutral stance itself-especially when it doesn't reflect the true state of
the analyst's feelings-and how often is it that we analysts feel truly
neutral? Wachtel (1987) suggests, "For some patients, the stance of
neutrality can contribute to their tendency to invalidate their own per-
ceptions and even to doubt their own sanity" (p. 66). The increasing
recognition and acknowledgment that the analytic relationship is a fully
human encounter between two, more alike than different, fallible hu-
man beings, imply that neutrality may be primarily a technical fiction,
more honored in the breach, rather than an analytic attribute.
However, what indisputably is an analytic attribute is the striving
to analyze and understand deviations from neutrality, which mayor
may not be countertransferential, and to deal with them openly in the
context of the therapeutic relationship. Ehrenberg (1982) observes,
"What defines an analytic relationship is that our impact, whether the
result of deliberate interventions or the result of inadvertent aspects of
our participation, must be explicitly clarified ... The hallmark of an ana-
lytic relationship is that it is essential that there be no covert manipula-
tion and that the patient be cognizant of whatever critical transactions
have occurred, as well as their impact" (p. 540). It is by virtue of this
openness that the essential attribute of psychoanalytic neutrality is
maintained, namely, that control of the patient's life remains in the pa-
tient's hands, not in the analyst's.
Anonymity of the analyst is considered essential to another central
dynamic of traditional psychoanalysis, the formation of the trans-
ference neurosis. The analyst scrupulously refrains from any self-
disclosure in order to avoid providing substitute gratifications that the
pqtient may get from the transference. This condition of abstinence fos-
ters the process of regression that lies at the core of the transference
neurosis. It can certainly result in an intensification of affect, but a
question has been raised about the nature of the regression. The theory
holds that the regression is temporal-to an earlier time in the person's
history; but critics claim that the regression is structural-to a lower
level of personality integration. Structural regression may be quite dan-
gerous-particularly to people whose personality integration is shaky
to start with. Aside from the danger, however, there is much uncertainty
about the relationship between transference neurosis and change. It
may well be that people get better in spite of a transference neurosis,
rather than because of one.
Show and Tell: Reflections on the Analyst's Self-Disclosure 51

To attribute change to a corrective emotional experience has, until

recently, constituted a denigration of the therapy involved. Further-
more, it has generally presumed a degree of self-revealing participation
on the part of the therapist, which has contributed to the feeling of
denigration. True change comes about through interpretation and in-
sight. However, with the advent of the deficit theory of psychotherapy,
alongside that of conflict theory, the corrective emotional experience has
attained an area of legitimacy. According to Kohut (1984), the patient
contrary to his experience in childhood, [requires the] sustaining
/I • • •

echo of empathic resonance [from the therapist, and if this constitutes a]

corrective emotional experience, ... so be it" (p. 78). That is a somewhat
defiant claim, as if anticipating criticism. But, increasingly, therapeutic
impact is attributed to the relationship, not primarily by making up for
missed parenting, but by providing a protected arena in which the
patterns of interpersonal experience can be confronted and illuminated.
To summarize thus far, as our understanding of conceptual issues
in psychoanalysis has expanded and modified, so too has our concep-
tion of the role of the therapist. The issues that seem most germaine to
the quality of the therapist's participation in the analytic process are the
nature of the data of psychoanalysis, the conception of transference, the
place of neutrality, the role of the transference neurosis, and the impact
of a corrective emotional experience. The changes in our understanding
of these issues have resulted in an evolving conception of the analyst's
role from mirror, to participant observer, to human being, or, as Michels
(1986) put it, "from authority to collaborator" (p. 488). Each succeeding
role does not displace the former, as in the Kuhnian sense of a succeed-
ing paradigm overthrowing a former one (1962), but rather exists
alongside the others. That is, most analysts seem to function in each role
at some time with the same patient and to varying degrees with different
patients. Of course, the analyst's theoretical allegiance might be ex-
pected to govern the predominance of one role over others. However, on
the basis of my experience working with people who have told me about
previous analyses with analysts whose theoretical positions are known,
I advise you not to presume too much. In any case, each succeeding role
does involve a greater degree of self-disclosure on the part of the analyst
than the former one. I now turn to the nature of that self-disclosure.
It is obvious that anonymity as such is always a matter of degree.
Analysts show themselves all the time in their dress, in their office
surroundings, in their manner of speaking, in the way they establish
time and money ground rules, and in the myriad ways of being that are
publicly observable. One person knew when my eyeglass prescription
changed. Another took me to task for the horrible painting I had on my
office wall. (Since I was a part-time tenant in someone else's office at the
52 Sabert Basescu

time, I was sorely tempted to disclaim any responsibility for the paint-
ing that I didn't like either.) Somebody was pleased that I didn't wear a
tie. Somebody else assumed I was going to a bar mitzvah when I did
wear one. (It was actually a funeral.) My books have been criticized. My
plants have been taken to mean that I'm good at making people grow.
My cough meant I was getting a cold. My eyes showed I was tired. My
car proved I didn't know much about cars, and the loud voice on the
other end of the phone indicated I was a henpecked husband. Not all of
such conclusions are accurate, but some are, and some are more accurate
than I initially gave them credit for being.
There are further, perhaps more profound, ways in which analysts
reveal themselves inadvertently. The questions asked and not asked, the
content focused upon, the connections made, the fleeting and not-so-
fleeting emotions invariably displayed, the facts remembered and the
facts forgotten-all convey information about the analyst's interests,
values, theories, anxieties, and emotions. Singer (1968) claims that an-
alysts are, at times, reluctant to make correct interpretations. "The more
to the point and the more penetrating the interpretation, the more ob-
vious it will be that the therapist is talking and understanding from the
depth of his own psychological life .... It takes one to know one, and in
his correct interpretation the therapist reveals that he is one" (p. 369).
Patients come to know their analysts through the shared experience
of the therapeutic relationship. The quality of that subjective knowing is
not simply dependent upon knowing about objective facts of the an-
alyst's personal life. Singer maintains that patients' readiness to know
their analysts-that is, to make use of the experience that is always
available to them-is a measure of their psychological health (1977).
So much for showing, which takes place whether we wish it or not.
Now about telling, which is deliberate, intentional, and chosen, al-
though it may also be experienced as driven, compelled, or manipu-
lated. What analysts tell their patients about themselves runs the full
range of personal facts, opinions, feelings, reactions, associations,
memories, experiences, fantasies, and dreams. Very few analysts tell all,
but some "wild" analysts do. It's a safe bet, however, that all analysts tell
something. The motivations, circumstances, and rationales vary tre-
mendously, as do the therapeutic consequences.
For example, Masud Kahn (1986) informed his patients of his
brother's death. He writes, " ... Analysts rarely speak about events in
their personal life that affect their work mutatively. The death of my
brother had changed my whole outlook on life, and I knew my patients
would sense it; so I told them as much. It is not a question of trans-
ference or countertransference, but actually real, lived life that makes
our fatedness or destiny, and about which we are often somewhat de-
Show and Tell: Reflections on the Analyst's Self-Disclosure 53

vious, both with ourselves and others" (p. 644). Similarly, Singer (1971)
reports that when his wife became seriously ill, requiring him fre-
quently to cancel appointments, he told his patients the reason.
One analytic candidate I was supervising learned suddenly that she
had a cancerous growth and had to have a mastectomy. In discussing
how best to inform her patients, she decided she would tell them in
general terms that she would be out for some weeks for surgery but she
did not feel comfortable being more specific than that. However, when
she returned to work after the surgery and was confronted by her pa-
tients' fantasies-especially the fantasies that were correct or near cor-
rect-she was unable to contain her own distress and burst into tears.
At that point she told them the fuller story.
Some years ago I had a back condition that left me unable to sit,
although I could stand or lie down comfortably enough. I chose to
continue working and informed the people I was seeing that I would
have to use the couch myself for about a month. I could discern no
disruptive impact on the work and have since talked with a number of
other analysts who have had similar experiences with similar results.
In none of these situations or a host of others like them have I heard
of destructive consequences for the analysis. One might anticipate that
the analyst's misfortune or infirmity would mobilize sadistic, vengeful,
or hostile impulses or, conversely, inhibit them. People do react in highly
individual ways; but a common theme seems to be the desire to be
helpful. The asymmetrical structure of the analytic relationship, with
the patient expected to be needy and the analyst helpful, can induce a
humiliating sense of uselessness in the patient, without the opportunity
for reality-oriented and constructive relatedness (see Singer, 1971). A
woman dreamed that when she came for her session, she found me on
the couch with a fever and she put a cool, damp washcloth on my fore-
head. We both understood the dream to mean that she wanted to be
helpful to me as I was to her.
One moral to be drawn from these experiences is that when the
analyst's life impacts upon his or her work, it is in the service of clarify-
ing the patient's attempts to make sense out of the relationship to acknow-
ledge the facts of life. However, there are dangers in such disclosures,
having less to do with the patient's ability to handle the facts and more to
do with the analyst's motives in disclosing them. If the analyst is exploit-
ing the patient by eliciting sympathy, warding off criticism or anger, or
manipulating a feeling of intimacy, then the disclosures are likely to be
destructively double-binding.
Other occasions on which I have found it useful to tell of events in
my life have to do with my feeling that some messages are better con-
veyed through recounting experiences than by saying what you mean.
54 Sabert Basescu

That is, in order to convey that I understand something that has been
told me, I might briefly tell of a similar experience that I've had. Or
when working with someone who feels so separate and different from
the rest of the human race, I might say something about myself that
bridges their feeling of distance.
One woman said, "I had a bad weekend. Other people are stable.
I'm so up and down. I hide my rockiness." I said, "Don't we all." She:
"You too?" I: "Does that surprise you?" She: "Well, I guess not. You're
human too." I understood that to mean she also felt human, at least for
the moment. On another occasion she expressed her anguish that some-
thing was so wrong with her because her therapy took so long. I said I
was in analysis for eight years, and that was only the first time. She said
she felt better knowing that I didn't feel she was taking too long and
wasn't fed up with her. I am aware that she may have meant something
was wrong with me because her therapy took so long, and that's an issue
we have also dealt with.
There are those inevitable times when the analyst'S personal issues
intrude upon the work and disrupt the patient's understanding of what's
happening. The most likely outcome is for the patient to assume the
blame and experience self-contempt. At such times it is essential that
the analyst acknowledge the intrusion. Ehrenberg (1984) puts it: "No
matter how entangled analysts find themselves they must be able to re-
establish the analytic integrity of the relationship. The process of so
doing actually becomes the medium of the analytic work, and may
involve making the analyst'S reactions explicit to engage the patient in a
collaborative way" (p. 563).
Prior to my taking a brief out-of-town trip, a man who knew where I
was going wished me a good time and began to tell me of interesting
things to do there. I somewhat brusquely replied that I'd been there
before. In the session following my return he said he was angry and had
been upset for hours after the previous session, feeling rejected by me,
as if something were wrong with him. Although these were characteris-
tic reactions of his, I suggested that there might be other possible expla-
nations. I went on to say that I did cut him off because I was not going to
have that kind of vacation and felt somewhat deprived about it. He said it
helped to know that and I said that he was always ready to see some-
thing wrong with himself. Sometimes there were things wrong with
others.
Michels (1983) asserts, "The primary data of psychoanalysis are
neither what happens in childhood nor what happens in adult life, and
not even the cause-effect relationship between them; the primary data
are what the patient says in the analyst'S presence, how the analyst
responds, and how the patient can make constructive use of the experi-
Show and Tell: Reflections on the Analyst's Self-Disclosure 55

ential and dialectical process" (p. 61). This points to what I think is the
predominant arena of analysts' self-disclosure, namely, what the an-
alyst says about his or her reactions to what transpires in the relation-
ship between the two people. It is predominant in importance, in
relevance to the therapeutic work, and in frequency of occurrence. It is
also probably the least controversial area of analysts' self-disclosure.
The patient-therapist relationship is the most immediate and expe-
rientially cogent arena in which to explore the patterns of interpersonal
relatedness and the role that each person plays in actively creating and
maintaining these patterns. What is unique about psychoanalysis, as
opposed to other therapies, is the focus on this relationship, the nature
and structure of which colors the way in which all other experiences are
dealt with in the analysis. That is, it acts like a filter system through
which other experiences are seen and processed. The exploration of this
filter system itself is the primary work of psychoanalysis.
The direct person-to-person encounter between patient and analyst
"creates a history together, experienced as relevant engagement, and
characterized by wholeness and complexity" (Held-Weiss, 1986, p. 3).
The truthfulness with which the participants can explore and acknowl-
edge what it is that's going on between them empowers the relationship
to be an agent for change. Lichtenberg (1986) describes it as " ... the
combination of the unique interaction of a relationship with tensions at
its junction and the joint search for meaning that constitute an analysis,
or rather that constitute the curative experience that a successful analy-
sis is" (p. 73).
The mutuality of relevant self-revelation works against the mysti-
fication of experience in the relationship and allows for the development
of intimacy and trust. In that context unattended-to or anxiety-laden
aspects of relatedness can be acknowledged and clarified, and resis-
tance overcome. Wolf (1983) suggests that, "Since in essence, resistance
is nothing but fear of being traumatically injured again, the decisive
event of its analysis is the moment when the analysand has gained
courage from these self-revelations of the analyst to know that the an-
alyst does not need to feed on the patient to achieve cohesion and har-
mony" (p. 500).
As I have written elsewhere (Basescu, 1987), I at times feel
prompted to express something I'm thinking or feeling in a session; but
I almost always respond to a patient's questioning me about it. If I am
asked, I generally answer. For example, a man, himself a therapist,
previously told me that he looks to see if I am glad to see him. This time,
as he scrutinizes me when I come to the waiting room, something
strikes me funny, and I can't stop myself from broadly smiling as he
enters the office. He asks me why I'm smiling and I tell him it's because
56 Sabert Basescu

he's scrutinizing me. He says, "That's no answer. I realize you don't have
to answer me." I say, "Your looking at me had a whimsical quality that
struck me funny." He says, "That's an answer. Thanks. That helps me
know something about myself." When I asked him what it helped him
know he told me that often people don't take him seriously and that
perhaps he doesn't present himself as serious.
A woman, who is familiar with psychotherapeutic literature but not
in the profession herself asked me if I would give her a reprint or refer-
ence for anything I've written. I told her I didn't care what she read but I
didn't want to give her what she asked for. She asked why not, saying
that she could get it on her own and this would simply save her some
trouble. That made sense to me but I still didn't feel right about doing it,
although I wasn't clear why. She pressed for a reason and I said, "Well,
let's see if I can be clear about it. It's because I don't want to participate in
or reinforce something that I don't know the meaning of. My job is to
analyze the meaning, not to collude with it." She said, "I understand
that," and then told me she wanted something of mine to have while I
was away on vacation. That then was what we dealt with.
I generally find that the process of answering questions about what
is going on with me at the moment helps clarify for both of us what's
happening. It often has the additional consequence of enabling further
exploration of the patient's experience. It conveys a respectful attitude
toward the other and enhances the spirit of collaboration.
Another class of personal reactions that I tend readily to express are
those that are discrepant with what seems to be going on. I've said
things like, "You're smiling while you tell me this, but I feel sad. I
wonder why," or, "I feel like I'm listening to a lecture," or "I have the
feeling of being buttered up." I think it is fairly common for analysts to
rely on their own reactive emotional sensibilities for clues to under-
standing the less obvious aspects of what is being enacted. Disclosing
these feeling reactions invites an experiential exploration of more than
meets the eye. It also conveys to the other person the kind of impact he or
she is having.
Vulnerable people tend to defend themselves against humiliation in
ways that often bring about the very hurts they are trying to avoid. The
therapeutic relationship affords a unique opportunity to experience
these defensive patterns and their consequences in a context that allows
for learning, not simply blind repetition. I saw a woman who was in
therapy with me, a therapist herself, at a professional meeting. From her
look and manner I gathered she would be more comfortable if I kept my
distance, which I did. In the session following she told me how hurt she
was that I was so unfriendly, as if I were letting her know that she should
make no mistake about the boundaries of our relationship. I told her how
Show and Tell: Reflections on the Analyst's Self-Disclosure 57

I had felt warned away by her appearance and thought I was complying
with her wishes. This led to our discussing other aspects of the same
pattern. I observed that she never expressed interest in any aspect of my
life, such as where I went on vacation or if I enjoyed it. She explained that
she was fearful of my seeing her as intrusive and slapping her down for
it. Her stance was that of rigid avoidance to forestall rejection. Her
impact was that of indifference.
In thinking about the way I say things to people in therapy sessions,
I realize that sometimes I know in advance what I'm going to say and
sometimes I don't. I may formulate something or mull it over momen-
tarily before I say it, or it may just come out. A woman said to me
critically that she never knew what to expect from me. I said, "That
makes two of us," and that just came out. Two weeks later she said my
remark stuck with her and she realized that unless you're rigid you don't
always know what you're going to say.
This bears upon the issue of the therapist's spontaneity. I think that
when I'm working effectively I am functioning spontaneously-and
that does not refer to whether or not I mull things over before I say them.
It refers to functioning freely in the mode appropriate to being the
analyst in a psychoanalytic relationship. One's way of being is influ-
enced by the nature of the relationship, as in a marriage or friendship, or
in a classroom or social gathering. The different structures elicit differ-
ent modes of being and different behaviors. The differences are a func-
tion of varying meanings, purposes, and intentions. The manifestations
of spontaneity vary as well.
While there clearly may be detrimental consequences to the an-
alyst's self-disclosures under the best of circumstances, I think most
problems are not caused by the analyst'S true spontaneity but by the lack
of it. That is, inappropriate self-disclosures are those compulsively
driven by the analyst's personal needs or they are responses to the
patient's intimidating manipulations. If the analyst is operating out of
countertransferential reactions, such as needing to impress the patient,
or being defensive, seductive, hostile, controlling, fearful, or placating,
then personal revelations are likely to be intrusive, diverting, burden-
some, inhibiting, or otherwise countertherapeutic. Saying whatever
comes to mind may be the mark of thoughtless impulsivity. Being fully
present, available, and freely responsive to the ongoing interpersonal
interactions are, to my mind, the hallmarks of spontaneity.
The fact that the distinctions are often difficult to make has led
many analysts to warn against self-disclosures. Gill (1983), for example,
is concerned that the analyst's subjective experience may be defensive
and that revealing it may result in shutting off further inquiry into the
patient's experience. He is wary about changing the patient's analysis
58 Sabert Basescu

into mutual analysis. He emphasizes the importance of the analyst

being especially alert to the patient's experience of any of the analyst's
revelations-a point with which I would strongly concur.
On the other hand, there are those like Coltart (1986), who writes,
"If we are too protective of our self-presentation and of what we consider
grimly to be the sacred rules of True Psychoanalysis, then we may
suffocate something in the patient, in ourselves, and in the process"
(p. 197). Or, as Symington (1986) refers to owning and expressing his
feeling reactions to the patient: '~gain when I acted from personal free-
dom rather than follow some specific technical regulation ... then thera-
peutic shifts occurred ... My contention is that the inner act of freedom
in the analyst causes a therapeutic shift in the patient and new insight,
new learning and development in the analyst" (p. 260).
Clearly, the analyst's self-disclosure is an intervention that can cut
both ways. However, we can no longer use what was always a mytho-
logically conceived position of anonymity as a way out. We are who we
are. It will show and we will tell, each of us in our own individual way.
Wolstein (1987) puts it: "Every psychoanalyst must seek a perspective
and create a technique that allow the deeply private gift of talent to show
itself; the inner voice gives a psychoanalyst the uniqueness of self and
the wholeness of personality" (p. 348). It behooves each of us, in keeping
with our professional responsibility to our patients, to do what we can
to insure that our showing and telling are primarily in the service of the
therapeutic enterprise, and not simply acts of self-indulgence.
One final word. In recent years I have written a number of self-
centered papers on my work as an analyst-on the anxieties of the
analyst (1977), the inner experience of the analyst (1987), and now this
one. Therefore, it was heartening for me to read that in research on
therapy outcomes, eight times as much outcome variance was accounted
for by therapist differences as by treatment differences. Luborsky (1987)
concluded: "The study of forms of treatment may be drastically less
enlightening than the study of therapists, yet there are phenomenally
more studies of the former" (p. 58). I took that as justification for my
focus in these papers.

References
Basescu, S. (1977). Anxieties of the analyst: An autobiographical account. In K.A. Frank
(Ed.), The human dimension in psychoanalytic practice. New York: Grune & Stratton.
Basescu, S. (1987). Behind the "seens": The inner experience of at least one psychoanalyst.
Psychoanalytic Psychology, 4, 3.
Coltart, N. (1986). 'Slouching toward Bethlehem ... ' or thinking the unthinkable in psy-
choanalysis. In G. Kohon, (Ed.), The British school of psychoanalysis, the independent
tradition. New Haven & London: Yale University Press.
Show and Tell: Reflections on the Analyst's Self-Disclosure 59

Ehrenberg, D. (1982). Psychoanalytic engagement: The transaction as primary data. Con-

temporary Psychoanalysis, 18, 4.
Ehrenberg, D. (1984). Psychoanalytic engagement II: Affective considerations. Contempor-
ary Psychoanalysis, 20, 4.
Gill, M. (1983). The interpersonal paradigm and the degree of the therapist's involvement.
Contemporary Psychoanalysis, 19, 2.
Gill, M. (1984). Psychoanalysis and psychotherapy: A revision. International Review of
Psychoanalysis, 11, 161-179.
Greenberg, J. (1986). The problem of analytic neutrality. Contemporary Psychoanalysis, 22, 1.
Held-Weiss, R. (1986). A note of spontaneity in the analyst. Contemporary Psychoanalysis,
22,1.
Jourard, S. (1971). Self-disclosure: An experimental analysis of the transparent self. New York:
Wiley.
Kahn, M.R. (1986). Outrageousness, complaining and authenticity. Contemporary Psycho-
analysis, 22, 4.
Kohut, H. (1984). How does analysis cure. (A. Goldberg & P.E. Stepansky, Eds.). Chicago:
University of Chicago Press.
Kuhn, T. (1962). The structure of scientific revolutions. Chicago: University of Chicago Press.
Levenson, E. (1981). Facts or fantasies: On the nature of psychoanalytic data. Contemporary
Psychoanalysis, 17, 4.
Lichtenberg, J. (1986). The tension between unrestricted personal revelation and circum-
scribed personal revelation. Contemporary Psychoanalysis, 22, 1.
Luborsky,1. (1987). Research can affect clinical practise-A happy turnaround. The Clini-
cal Psychologist, 40, 3.
Michels, R. (1983). Contemporary views of interpretation in psychoanalysis. Psychiatry
update, VII. (1. Grinspoon, Ed.). Washington, D.C.: American Psychiatric Press.
Michels, R. (1986). How psychoanalysis changes. Journal of the American Academy of Psycho-
analysis, 14, 3.
Singer, E. (1968). The reluctance to interpret. Uses of interpretation in treatment. (E. Hammer,
Ed.). New York: Grune & Stratton.
Singer, E. (1971). The patient aids the analyst. In the name of life. (B. Landis & E. Tauber,
Eds.). New York: Holt, Rinehart & Winston.
Singer, E. (1977). The fiction of analytic anonymity. The human dimension in psychoanalytic
practice. (K.A. Frank, Ed.). New York: Grune & Stratton.
Stern, D. (1985). The interpersonal world of the infant. New York: Basic Books.
Symington, N. (1986). The analyst's act of freedom as agent of therapeutic change. The
British school of psychoanalysis. The independent tradition. (G. Kohon, Ed.). New Haven &
London: Yale University Press.
Wachtel, P.(1986}. On the limits of therapeutic neutrality. Contemporary Psychoanalysis, 22, 1.
Wolf, E.S. (1983). Concluding statement. The future of psychoanalysis. Essays in honor of
Kohut. (A. Goldberg, Ed.). New York: International Universities Press.
Wolstein, B. (1987). Experience, interpretation, self-knowledge. Contemporary Psycho-
analysis, 23, 2.
 5
Self-Disclosure in
Rational-Emotive Therapy
Windy Dryden

In this chapter I will first outline briefly the basic principles of rational-
emotive therapy; then consider how rational-emotive therapists view
client and therapist self-disclosure; and, finally, deal with common ob-
stacles to such self-disclosure and how these may be overcome.

The Basic Principles of Rational-Emotive Therapy

Rational-emotive therapy holds that people are disturbed not by
events but by their view of events. More specifically the theory postulates
that when people are psychologically healthy, they adhere to nondog-
matic preferences even though events may go against their preferences
(e.g., "I want to be approved by Susan but I don't have to be. It is
unfortunate that Susan doesn't like me"). However, when people be-
come psychologically disturbed they tend to make absolute demands
out of their preferences (e.g., "Susan must like me. It's terrible that she
doesn't"). When people think in such rigid ways they tend to draw
irrational conclusions from their dogmatic premises (i.e., their musts).
Thus they tend to conclude that whenever they do not get what they
think they must that (1) it is awful (meaning more than 100% bad); (2)
they cannot stand it (meaning that they can never be happy again as long
as the "awful" events in their life are present); and (3) they, other people,

Windy Dryden • Department of Psychology, Goldsmiths' College, University of Lon-

don, New Cross, London SE14 6NW, England.

61
62 Windy Dryden

and/or life conditions are damnable. A basic goal of rational-emotive

therapists is to help their clients to identify (1) their disturbed emotions
and self-defeating behaviors; (2) the events that trigger the irrational
beliefs that lead to these disturbed emotions and behaviors; and (3) the
irrational beliefs, to which they devoutly cling. After helping clients to
identify such irrational beliefs, rational-emotive therapists then encour-
age them to dispute their irrational beliefs vigorously by using various
cognitive, emotive, and behavioral means (Ellis & Dryden, 1987).
The role of rational-emotive therapists in the therapeutic process is
usually a direct and educative one. RET therapists strive to teach their
clients the ABC theory of emotional disturbance and educate them in
their active role in disputing their own irrational beliefs cognitively,
emotively, and behaviorally.

The RET Approach to Client Self-Disclosure

RET is a structured approach to psychotherapy and, as such, RET
therapists generally encourage their clients to disclose themselves,
using the ABC framework of psychological disturbance (where A = the
Activating event, B = Belief, and C = Emotional and Behavioral Conse-
quences of those beliefs). However, it is recognized that some clients do
benefit from disclosing their problems and their feelings about them in a
fairly unstructured way in the early stage of therapy.
A typical sequence of structuring client self-disclosure in RET is as
follows. First the therapist asks the client to focus on one psychological
problem at a time. This may be a problem that the client finds most
distressing in his life or one that he wishes to address first in psycho-
therapy. When both therapist and client agree on the nature of the cli-
ent's problem in broad terms, the therapist then attempts to assess the
client's problem according to the ABC framework. Typically, the thera-
pist starts with C, the client's major disturbed emotional response. Here
the RET therapist will encourage her client to be as specific as he can
about this emotional response. In general, when clients disclose their
emotional problems in vague terms such as "I feel upset," "I feel bad,"
and "I felt miserable," RET therapists attempt to help them to clarify
these problems and, in particular, whether the negative emotion was
appropriate or inappropriate to the activating event at A.
According to RET theory, appropriate negative emotions stem from
clients' rational, undogmatic beliefs which are normally expressed in
the form of wishes, wants, and preferences. Major negative emotions
that stem from these rational beliefs are sadness, concern, annoyance,
and regret-emotions that are constructive responses to negative life
Self-Disclosure in RET 63

events and that help people adjust to those events and then to move on
with their lives. Such emotions are distinguished from inappropriate
negative emotions which, according to RET theory, stem from dogmatic
irrational beliefs. Such emotions are anxiety, depression, anger, and
guilt-emotions that are seen as being unconstructive responses to neg-
ative life events and that inhibit people from adjusting to those events
and from getting on with their lives.
While helping the client to distinguish his inappropriate from his
appropriate negative emotions at C, the therapist will often help the
client to distinguish between irrational or rational beliefs at B. Assum-
ing that the client has a disturbed inappropriate negative emotion at C,
the RET therapist will proceed to encourage the client to disclose what
was the triggering activating event at A in the ABC framework. Here the
RET therapist will encourage her client to disclose a specific example of
the activating event; this is because the client, in real life, reacted to a
specific activating event and his irrational belief was in fact triggered by
such a specific event. The therapist will discourage her client from de-
scribing activating events in vague or overly discursive terms, since such
disclosures will not aid the identification of specific irrational beliefs at
B, later in the assessment process.
At this phase of assessment a particularly powerful intervention
tool is the use of "inference chaining" (Moore, 1983). In RET theory,
A stands not only for the event but also for the client's interpretations
or inferences about the event, and it often occurs that clients make
themselves disturbed not so much about the actual event but about the
inferences that they make about the event. In inference chaining the
therapist seeks to help the client to identify and disclose the most rele-
vant inference in the chain (Le., the one that served as a trigger for the
irrational belief).
A brief example of inference chaining follows:
Therapist: So at point C you felt anxious. Now what were you anx-
ious about? (Here the therapist encourages the client to disclose what it
was about A that he was disturbed about.)
Client: I was anxious because I thought that the woman might
reject me.
Therapist: And what would be anxiety-provoking in your mind if she
did reject you?
Client: All my friends would see this and they would laugh at me.
Therapist: And what would be anxiety-provoking about that in
your mind?
Client: Well, if my friends would laugh at me, I would gain the
reputation of being a wimp.
Therapist: And if people generally thought of you as a wimp ... ?
64 Windy Dryden

Client: Oh my God, I couldn't stand it, that would really be horrible.

In this clinical exchange it can be seen that while the initial reported
A was rejection, the client was really anxious about the psychological
implications of this rejection. Thus, using inference chaining, the thera-
pist structured the client's self-disclosure in a way that helped the client
to identify the core aspect of A that served as a trigger for his irrational
belief: "I must not be thought of as a wimp."
After assessing both C and A, RET therapists then encourage their
clients to identify and disclose the irrational beliefs that account for their
psychological disturbance at C. There are two major strategies that can
be used to identify such irrational beliefs. First is through the use of
such open-ended questions as "What were you telling yourself about
that experience to make yourself feel anxious?" The problem about this
strategy is that clients then disclose aspects of their thought processes
that are not irrational beliefs. Thus, they may often disclose automatic
thoughts (not in the form of irrational beliefs) and inferences or inter-
pretations that again do not lie at the core of their emotional problem. If
this occurs, the rational-emotive therapist will explain to the client why
that particular thought would not be sufficient to account for his emo-
tional problem. Through the subsequent use of guided questions and
short didactic explanations, the therapist is generally successful in help-
ing the client to identify the major must in his thinking which did ac-
count for C.
A second strategy at this point is to ask questions that are guided by
RET theory. Instead of asking: "What were you telling yourself about
that experience at A to cause your anxiety to point C?" the therapist asks
such questions as: "What must were you telling yourself about A that
caused C?" The danger of using such a strategy is that the therapist may
put words into the client's mouth. However, the advantage of this type of
theory-guided question is that it encourages the client to identify effi-
ciently the musts in his thinking.
At this point the RET therapist has two major tasks. First, while
encouraging disclosure of the client's irrational beliefs the therapist will
educate the latter concerning the important distinctions between ra-
tional and irrational beliefs. Second, it is helpful if the therapist encour-
ages her client to disclose his irrational beliefs both in the form of a
premise, i.e., the musts and demands, and the conclusions derived from
such premises (i.e., awfulizing, I can't stand it-itis, and damnation).
When the client can see the relationship between his irrational be-
liefs and his emotional problems at point C, the therapist is then in a
position to help him to dispute his irrational beliefs and to encourage
him to practice doing this outside therapy sessions. To facilitate this the
therapist often encourages the client to undertake certain homework
Self-Disclosure in RET 65

assignments, the goal of which is to encourage the client to begin to

internalize his new rational philosophy. As therapy proceeds the client's
self-disclosure tends to center on (1) reporting back on his experiences of
doing homework assignments, and (2) bringing up new problems that
are approached in a similar way to that outlined.
It can be seen, then, that rational-emotive therapists do not give
their clients free rein to disclose themselves in whatever way they
choose. If given such free rein, clients will often bring up irrelevancies,
sidetrack themselves, and generally discourage themselves from adopt-
ing a problem-solving approach towards their psychological problems.
Having said this, the use of clinical flexibility is advised in varying the
structure of RET according to the therapeutic requirements of given
clients at given points in the therapeutic process. Thus, some clients will
require and benefit from a less structured approach on the part of their
therapists if they are to disclose their concerns in a meaningful way. This
is particularly the case if they are ashamed about disclosing certain
experiences.
In addition, the more a client is successful at using RET methods
during the middle and end phases of therapy, the less the therapist's role
is a direct one and the more she will encourage the client to structure his
disclosures for himself during this period. Here the therapist may do
little more than to make interventions such as, "OK, that was your A,
now what was your irrational belief? .. Fine, how did you challenge
that? ... Good, what was the result of doing that? ... Fine, what home-
work assignment did you give yourself? .. that sounded good." The
purpose of this gradual shift in therapeutic style from "active-directive"
to "prompting-encouraging" is twofold. First, it helps the client to gain
increasing control over the therapeutic process. Second, it encourages
the client to be his own therapist so that he can disclose his problems to
himself and use the RET method of problem assessment and solution to
help himself.

Therapist Self-Disclosure in RET

One of the basic aspects of the therapist's role in RET is to educate
the client in the ABCs of his emotions (Dryden, 1987). As such however,
the therapist will freely disclose her own experiences in the service of
making that educational experience a memorable one for her client.
In order to understand fully the RET position on therapist self-
disclosure, it is first necessary to outline the RET view of human falli-
bility (Ellis, 1972) since this is central to such understanding. The RET
theory of human fallibility states that all humans are equal in humanity,
66 Windy Dryden

that there are neither good humans nor bad humans and that no human
being is more valuable or more worthy than any other. All people are
equal in humanity although they may be unequal in terms of their
different traits, behaviors, thoughts, feelings, etc. Thus the RET thera-
pist does not see herself as being more valuable than her client, although
she will tend to consider that she is more knowledgeable about under-
standing emotional problems.
Given that the effective RET therapist would accept herself for her
errors and flaws and for past and present emotional disturbances, she
will, as often as is therapeutically advisable, show her client how she
upset herself about experiences similar to those with which her client is
concerned and how she used RET to overcome such emotional distur-
bances. Note that in choosing this mode of self-disclosure, the RET
therapist is providing her client with a coping model of overcoming
emotional disturbance and not with a mastery model. The therapist who
employs a mastery model approach to self-disclosure will stress that she
has never experienced a problem similar to the client's because she
thinks rationally about similar events with which the client is strug-
gling. This approach is unproductive because it unduly emphasizes the
inequality between therapist and client and deemphasizes their shared
humanity.
A coping model of self-disclosure, on the other hand, where the
therapist outlines that she too has experienced or is currently experienc-
ing similar emotional disturbances but is able to get over these by using
RET methods and techniques, indicates to the client that both therapist
and client share the same experiences, although one is more adept at
present in overcoming them than the other. Such a coping model em-
phasizes the shared humanity of the therapist and client while not bela-
boring the inequality that exists between therapist and client in the
therapeutic enterprise. The therapist who utilizes the coping model of
self-disclosure can furthermore outline the process of solving emotional
problems for the client, and as such self-disclosure can often be a power-
ful therapeutic tool.
Let me use a personal example to illustrate this. I used to have a
very bad stammer and was not only ashamed about this but also anxious
about speaking in public because I was scared that if I revealed my
stammering in public, other people would laugh at me and I would
severely condemn myself if this occurred. I often disclose this fact to
clients who not only experience similar problems concerning stammer-
ing but who also have problems that are exacerbated by their anxiety
that these problems may be revealed publicly. My self-disclosure is often
along. these lines:
"You know, as we find out r.lOre about your problem I am myself
Self-Disclosure in RET 67

reminded of a problem that I used to have which in certain ways is quite

similar to yours. I don't know if you've noticed but I have a stammer-
here the client usually says, 'Well yes, I have noticed it but it's really not
that noticeable' (indeed, I rarely stammer these days although I still have
a slight speech hesitancy). I used to have a very bad stammer and hid
myself away because I used to tell myself, "I must not stammer in pub-
lic. It would be terrible if I did and I couldn't stand it if other people were
to see me stammer and to think badly of me." Well, I struggled with this
problem for many years and received much inadequate help from var-
ious speech therapists. However, it wasn't until I heard a radio program
on which a noted entertainer outlined his own approach to overcoming
his stammering problem that I started to overcome mine. This man told
how he decided to force himself to speak up in public while reminding
himself that if he stammered, he stammered, too bad. This was the first
good piece of advice I'd heard on overcoming anxiety about stammering
and I resolved to apply this myself. Indeed, although I did not realize it,
I used the principles of RET which I'm now going to teach you. What I
did was to force myself to enter situations and speak up, but before I did
so I prepared myself by telling myself that there is no reason why I must
not stammer, and if I did, too bad. On occasion I would speak more
vehemently to myself and say things like; "If I stammer, I stammer, fuck
it!" The more I internalized these beliefs, the more I was able to go into
situations and speak up. It certainly wasn't easy and I did have setbacks,
but I persisted and now I can speak without anxiety in a variety of
public situations, including radio and television. I still make myself
anxious at times, but when I do, I look for and dispute my irrational
beliefs in a very powerful and vigorous way and push myself forward on
the basis of my rational beliefs. Even on the odd occasions when I cop
out, I refuse to condemn myself and fully accept myself as a person who
has opted out at a given moment. So you see, I too have experienced
similar problems but have managed to help myself enormously. So I
have a lot of faith that if you apply similar techniques you could also
gain a lot of benefit from these methods."
While I have presented this personal self-disclosure in uninter-
rupted form, in practice, parts of it are interspersed with dialogue with
the client concerning what he or she can learn from my experience.
It should be noted that this self-disclosure illustrates for the client
the rational-emotive approach to therapeutic change. In this personal
example I show the client (1) how to identify a personal problem; (2) how
to identify the rational belief that underpins the problem; (3) the impor-
tance of repetitive and forceful disputing of this belief in situations in
which the problem occurs; (4) that setbacks will occur and that under
certain circumstances, people will choose to avoid rather than confront
68 Windy Dryden

their problems; and (5) the importance of accepting themselves when

this happens. When the therapist discloses personal information for
educative purposes it is important that she ask her client what he can
learn from her experience. It should not be forgotten that the purpose of
therapist self-disclosure is to aid the learning process of the client. It is
not an opportunity for the therapist to boast about her achievements in
overcoming personal problems. Rather, the philosophy that should pref-
erably underpin therapist self-disclosure is: "You and I are equal in
humanity. At the moment I have more experience and skills in overcom-
ing emotional problems but you can learn this too. It is difficult, but if
you persist with it you can experience as much benefit as I did."

Cautions

While therapist self-disclosure does have great therapeutic merits,

therapists should not disclose themselves indiscriminately to their cli-
ents; and I will now outline circumstances in which it may be preferable
for therapists not to disclose themselves to their clients.
First, therapist self-disclosure, like any form of therapist communi-
cation, needs to be considered within the wider framework of the thera-
peutic alliance (Bordin, 1979). For example, in my experience, it is
probably not wise for therapists to disclose their own problems and how
they overcame them at a very early stage in the therapeutic process. This
is so mainly because clients may not view such early self-disclosure as
appropriate therapist behavior, and this may threaten the therapeutic
alliance (Dies, 1973). This being so, some clients will, however, experi-
ence benefit from early therapist self-disclosure and therapists need to
use their therapeutic judgment and their knowledge of their client as
guides concerning the wisdom of making such disclosures.
Second, RET therapists are cautioned against disclosing themselves
to clients who seek a formal relationship with their therapist. I made
this mistake once when I disclosed a piece of personal information to a
client who responded in this way: "Well, young man, that's all very
interesting but I'm not paying you good money to hear about your
problems, will you please address yourself to mine." This client wanted
her therapist to act in a formal manner and did not value the use of
therapist self-disclosure which, parenthetically, does seem to be associ-
ated with therapist informality. This is perhaps one reason why RET
therapists in general favor therapist self-disclosure in that they favor
adopting, whenever possible, an informal therapeutic role with their
clients.
Third, RET therapists should be wary about disclosing themselves
to clients who might use such information to harm themselves, or their
Self-Disclosure in RET 69

therapists. For example, there are clients who idealize their therapists
and for whom disclosure of therapist fallibility may come as a very
painful blow, with the result that such clients may make themselves
(albeit needlessly) depressed and anxious about this. Other clients may
distort the content and the purpose of therapist self-disclosure to dis-
credit the therapist in his or her community. It is difficult for RET thera-
pists to predict which clients will have such negative responses to
therapist self-disclosure; but it is possible to gain such information, and
certain signs in the clients' psychopathology may provide clues for ther-
apists in this respect.
For example, if a client has a history of extreme anger and vengeful-
ness when their view of a person is threatened, this is perhaps a clue
that the therapist may not wish to disclose personal information to the
client that may threaten the client's view of the therapist. However, it
should be noted that unless there are signs to the contrary, RET thera-
pists do tend to use self-disclosure whenever therapeutically advisable
and will often take risks (although not foolhardy risks) in this regard.
Of course RET therapists can never guarantee that their self-disclosures
will have positive effects. Therapists who demand certainty that their
clients will react favorably to their disclosures will probably never self-
disclose. Given the fact that RET therapists are not afraid to take calcu-
lated risks in therapy, they will take the chance of gaining therapeutic
leverage by disclosing their problems and how they overcame them after
disputing any demands they may have about this being acceptable to
the client.
Now that I have outlined the value and risks of therapist self-dis-
closure in RET, I would like to emphasize how important it is for thera-
pists to elicit feedback from their clients concerning the impact of their
self-disclosures (Beck, Rush, Shaw, & Emery, 1979). Thus at the end of a
session during which I have disclosed to a client some of my problems
and how I have overcome them, I generally ask the client what impact
this had on him, how he felt about my disclosure, what he learned from
my disclosure, and whether or not he preferred me to disclose this
information. If the therapist establishes her own system of feedback
with the client, then it is possible to gauge the likely future benefit of
therapist self-disclosure with that client. When a client indicates that
therapist self-disclosure is not helpful, then that is perhaps a good
guide for the therapist not to disclose her problems and the way she
overcame them in future to that client.

Disclosing Personal Reactions to the Client

While I have so far focused on one major feature of therapist self-
disclosure, namely disclosure of problems and how these have been
70 Windy Dryden

overcome, there is another aspect of self-disclosure that I would like to

address in this chapter-the issue of providing clients with feedback
concerning one's personal reactions to them. When clients talk about
such issues as not getting on with people, I look for possible ways in
which they may antagonize people by monitoring my own reactions to
them in the therapy session. It sometimes occurs that I get a clear indica-
tion that a client's mode of interaction with me may, if reproduced with
other people, lead these other people to shun the client.
For example, one of my clients developed the habit of putting his
feet up on my furniture. His presenting problem was that he felt quite
lonely and didn't get on with people. I not only shared with him my
reaction of displeasure whenever he did this, but was also keen to show
him that while I disapproved of his behavior, I did accept him as a
person. I told him that while I did not demand that he must not under
any circumstances continue to put his feet on my furniture, I would, if
he continued to do so, exercise my right to terminate the therapeutic
relationship. Later on in the therapeutic process he told me that he really
valued my feedback on his interpersonal behavior (although he did not
appreciate it at the time!) because he could see in a very clear way the
negative impact that he was having on other people.
In this example I have stressed an important aspect of the RET
approach to disclosing personal reactions to clients-namely, that it is
important to make a distinction between the person's behavior from the
person as a whole and to teach this principle to the client. While the
client is encouraged to take responsibility for his behavior, he is shown
that he does not equal his behavior. Thus when the therapist brings to
the client's attention some problematic aspect of his behavior she demon-
strates unconditional acceptance of the client as a person but takes a no-
nonsense approach to drawing attention to the negative aspects of the
client's behavior.
RET therapists are again advised to use clinical judgment before
disclosing their personal reactions to their clients. For example, clients
who very easily upset themselves about even minor criticisms need to
be quite adept at using RET methods to overcome such strong reactions
before therapists disclose their negative reactions to problematic aspects
of their clients' interpersonal behavior. This is true whether or not such
clients ask for such feedback.
In general, whenever clients ask me for my opinion of them, I use
this as an opportunity to teach them RET, particularly if I do have a
negative reaction to them, and I sometimes disclose this reaction with-
out being asked, as in the example just provided. Such disclosure needs
to be made tactfully, and it is important for the therapist to pay attention
to the language she uses to disclose her negative reactions to aspects of
Self-Disclosure in RET 71

her clients' behavior. In addition to showing the client that he does not
equal his behavior, it is also important that the client be shown that,
although he is acting in a way that the therapist finds negative, he does
not have to continue to act that way, and that the therapist has faith and
confidence that he can improve his behavior. I have personally found the
combination of both disclosing negative reactions about certain aspects
of my clients' behavior in the context of teaching the RET position on (1)
the difference between the person and his acts, and (2) the possibility of
change and providing encouragement, to be especially therapeutic.

Overcoming Obstacles to Disclosure in

Clients and Therapists
There are many reasons that both clients and therapists do not
disclose their experiences, feelings, and problems during the therapeu-
tic process and, in this concluding section, I outline some of the main
explanations for disclosure avoidance and what RET therapists can do
about this phenomenon.

Clients
In my experience there are three main reasons clients do not dis-
close their experiences and problems to their therapists in RET: (1)
shame, (2) need for the therapist's approval, and (3) reluctance to partici-
pate in the therapeutic process.
When clients are ashamed about disclosing their experiences to
their therapists they tend to believe that they must not have these prob-
lems in the first place and that they are in some way unworthy individ-
uals for having them. Thus, rather than disclose both the nature of their
original problem to themselves and their therapist, they unwittingly
give themselves a second problem (Le., shame about the original prob-
lem) that accounts for their disclosure avoidance. If this is the case, it is
important for the RET therapist to deal with the client's shame about the
problem before encouraging him to disclose the nature of this problem.
If the client does admit to feeling shame, one way of doing this is to label
the client's problem "X" and help the client to see that "X" is really the
activating event (A in the ABC framework) and the feeling at C is shame.
The client can then be helped to identify the irrational beliefs at B that
underpin his experience of shame. If this assessment proves to be cor-
rect and the client acknowledges that this is the case, then the RET
therapist can deal with the irrational beliefs about the undisclosed prob-
lem without having to know what the problem is. Then, having been
72 Windy Dryden

helped to overcome his shame about the problem, the client may find it
easier to disclose the problem to his therapist.
The second reason a client avoids disclosure of his problems is that
he fears that if he discloses the problem to the therapist she would
somehow disapprove of him and he would condemn himself because he
thinks he needs the therapist's approval. First, it is important to ascer-
tain that this is the reason the client does not disclose the true nature of
his problems and, if so, this is again dealt with using the ABC frame-
work, with A = the prospect of losing the therapist's approval, B = "I
need the therapist's approval and I am less worthy if I don't have it," and
C = anxiety. Then the therapist can help the client to dispute and
change the irrational beliefs that underpin the anxiety that stops him
from disclosing the true nature of his problems. Once again, if this
proves successful, the client is likely to disclose his problems after he
has overcome his need for the therapist's approval.
The final reason for the client's unwillingness to disclose his prob-
lems to his therapist is a general reluctance to being a client in the first
place. This often occurs when the client is told that if he does not partici-
pate in the therapeutic process, he will incur a penalty, for example,
from the courts, or from his partner who may leave the relationship. My
approach to this situation is to show the client that there is no reason he
has to disclose his problems to me or to participate fully in the therapeu-
tic process and that he has every right not to do so. However, I also point
out to the client that since he is choosing to attend, even under duress,
he might as well work on a problem as defined by him rather than work
on a problem that has been defined for him by a third party. Once the
client sees that I am on his side and not on the side of the referring agent,
he is more likely to see me as an ally and begin to use the therapeutic
process for his own benefit rather than for the benefit of others.

Therapists

RET therapists are usually quite willing to disclose not only their
problems and how they have overcome them but also their personal
reactions to their clients; although, as I have suggested, such disclosure
needs to be made in the context of sound clinical decision making.
However, some RET therapists are reluctant to employ self-disclosure in
this way and, in my experience in supervising such therapists, there are
three main reasons that this occurs: (1) a need to be seen as thoroughly
competent by the client; (2) a need for the client's approval; and (3) the
belief that therapists should not have psychological problems.
When RET therapists believe that they have to be competent under
all conditions, they tend to avoid the appropriate use of therapist self-
Self-Disclosure in RET 73

disclosure because they predict that if they disclose that they have had
emotional problems, even though they have overcome them, their clients
will judge them as being incompetent; and if this was the case, they
would condemn themselves for this. While supervising therapists who
have this belief, I have used a double-barreled approach to this problem.
First, I encourage the therapist concerned to assume that her worst fear
is realized, i.e., that if she discloses herself to her clients they will indeed
see her as being incompetent as a therapist. Having encouraged her to
imagine that her worst fear has come true, I then help her to see that it is
her beliefs (B) about this situation (A) that leads to her reluctance to self-
disclosure at C. I then help her to identify and to challenge the irrational
belief that underpins this experience, namely: "I must be seen as a
competent therapist, otherwise I'm unworthy." When this has been
done, the therapist is in a better position to reassess logically the likeli-
hood that her clients will actually see her as incompetent. Here I use
both my own example of past self-disclosure to clients (as outlined
earlier in this chapter) and the fact that Albert Ellis (the founder of RET)
also employs self-disclosure to show that competent RET therapists do
self-disclose and that there seems to be little evidence that our clients
generally see us as less competent (although some may have done so in
the past).
The second reason RET therapists are reluctant to self-disclose is
their need for their clients' approval. This is related to the need to be
seen as competent; but here the therapist is more concerned with the
approval of her clients than with their judgments of her competence.
Again I suggest a double-barreled approach to this issue - helping the
therapist first to identify and challenge her irrational beliefs before help-
ing her to reevaluate the likelihood that her clients will disapprove of her
if she does disclose to them some of her personal experiences.
Finally-and this is perhaps more true of novice therapists than
more experienced ones-I find that some RET therapists have a dire
need to see themselves as thoroughly mentally healthy. This is, in fact, a
paradox, since if they demand that they must have perfect mental health,
they are in fact disturbed because of the very existence of such a de-
mand. This need to be problem-free stems partly from a misunder-
standing of what it means to be a therapist. Being a therapist does not
mean that one must be free of all psychological problems; rather that one
has such problems, but can use RET techniques to overcome them. The
approach to helping a therapist overcome this rigidity is quite similar to
what has already been outlined in this chapter. I first encourage her to
assume that her unrealistic expectation is true, namely that good thera-
pists do not have any emotional problems. Then I help her to see that
there is no reason why she must be a good therapist by this criterion
74 Windy Dryden

and, if she is not, she can still accept herself and continue to overcome
her problems. I then help her to reevaluate her unrealistic expectation
and encourage her to see that being a good therapist does not mean
being problem-free but means, in part, that one can apply what one is
teaching others to oneself and one's own life situation. In using RET to
help RET therapists in these ways, it is my experience that they become
less anxious about disclosing themselves to their clients and do so ap-
propriately and therapeutically during the process of RET.

References
Beck, A. T., Rush, A.J., Shaw, B.E, & Emery, G. (1979). Cognitive therapy of depression. New
York: Guilford.
Bordin, E.S. (1979). The generalizability of the psychoanalytic concept of the working
alliance. Psychotherapy: Theory, Research and Practice, 16, 252-260.
Dies, RR (1973). Group therapist self-disclosure: An evaluation by clients. Journal of
Counseling Psychology, 20, 344-348.
Dryden, W. (1987). Counselling individuals: The rational-emotive approach. London: Taylor &
Francis.
Ellis, A. (1972). Psychotherapy and the value of a human being. In W. Davis (Ed.), Value and
valuation: Aetiological studies in honor of Robert A. Hartman. Knoxville: University of
Tennessee Press.
Ellis, A., & Dryden, W. (1987). The practice of rational-emotive therapy. New York: Springer.
Moore, RH. (1983). Inference as "PC in RET. British Journal of Cognitive Psychotherapy, 1 (2),
17-23.
 6
Self-Disclosure in Psychotherapy and
the Psychology of the Self
Lawrence Josephs

A chapter on the psychology of the self is particularly apropos in a book

on the role of self-disclosure in psychotherapy, for how better to grasp
the nature of the self that is disclosed in the act of self-disclosure than
through the insights of a school of thought devoted to the systematic
study of the self? Self-disclosure in psychotherapy will be examined in
the light of three interrelated ideas: (1) the concept of the self as a psy-
chological structure through which self-experience assumes its charac-
teristic quality and enduring organization, (2) the relationship between
the experiential sense of self and the verbal sense of self, and (3) the
intersubjective nature of self-experience. It will be proposed that the
essential process of self-disclosure in psychotherapy occurs pre-
reflectively and at a nonverbal level and is expressed in the enduring
emotional ambience in which treatment transpires. The ambience of
treatment is a product of the therapeutic dyad's unique manner of being
with and handling each other over an extended period of time. Each
member of the therapeutic dyad brings to the encounter his or her indi-
vidualistic somato-affective presence through which each discloses
some private essence of personal selfhood. Such a disclosure of self is a
fundamentally intersubjective process dependent upon a capacity to
evoke, register, and assimilate the self that the other is attempting to
disclose. Self-disclosure as a communicative act requires a receiver as

Lawrence Josephs • Institute of Advanced Psychological Studies, Adelphi University,

Garden City, New York 11530.

75
76 Lawrence Josephs

well as a transmitter. As each member of the therapeutic dyad engages

in self-disclosure, the receiving member must discover, decipher, con-
struct, and create a representation of the other's self from innumerable
experiences of the therapeutic interaction.
For the patient, verbal self-disclosure is a crucial element of "the
talking cure." Finding the right words to represent, evoke, and express
the experiential self constitutes the integrative process through which
the patient gains a sense of his own reality, wholeness, authenticity, and
genuineness as a person. In addition to serving a communicative func-
tion in the service of psychic intimacy, the patient's verbal self-disclosure
serves as a vehicle of seeing the self in perspective in listening to one's
own self-perceptions said out loud. The process of self-articulation in
verbal self-disclosure serves to develop a better integrated as well as a
more clearly defined sense of self. Nevertheless, verbal self-disclosure is
fraught with potential pitfalls to the extent that the verbal conception of
self proves to be incongruent and discrepant with the experiential self.
As Freud discovered, words can conceal as easily as reveal meaning.
When words serve to hide the experiential self from others as well as
from oneself, the verbal self can be said to be false, inauthentic, and
non-genuine. The difficult task of psychotherapy is then to overcome
such self-alienation in restoring the vital link between verbal self and
experiential self that had been severed or perhaps never formed in the
first place.
Given the double-edged nature of verbal self-disclosure, in that it
conceals as it reveals, the therapist's verbal self-disclosure may be of
dubious value. How can the therapist guarantee the genuineness of his
verbal self-disclosure, given that his self-statements will not be sub-
jected to the rigorous analysis, questioning, and challenging to which
the patient's verbal self-reports are subjected over the course of psycho-
therapy? Can the therapist's self-analysis in the heat of the counter-
transferential moment be counted upon to ensure authenticity? Even
if the therapist could ensure a congruence between his verbal self-
disclosure and his experiential self as revealed to the patient in his
somato-affective presence, such verbal self-disclosure may foreclose the
patient's discovery of the therapist's self through the patient's own intu-
ition based upon his experience of the therapist as a person. To the
degree that the patient experiences the therapist's verbal self-disclosure
as received wisdom to be taken at face value, the patient may feel that
the therapist's perception of himseif has more credence and takes prior-
ity over the patient's perception of the therapist.
Despite these caveats, one useful role of therapist verbal self-
disclosure may be to clear up instances of misunderstanding that are
inevitable over the course of psychotherapy. No matter how sincere the
Self-Disclosure in Psychotherapy 77

therapist's empathic intent, empathy remains imperfect since, after all,

therapist and patient are two separate people who can never live inside
each other's heads, no matter how imaginative their empathic efforts.
Subsequent to a failure of empathy on the therapist's part and the mis-
understanding that arises as a consequence, it may be useful for the
therapist to disclose some of his thoughts and feelings so that the pa-
tient can better understand the therapist's perspective. In appreciating
the therapist's perspective, the patient can better see where the therapist
was coming from when his understanding was mistaken. In grasping
the nature of the therapist's human fallibility and lack of omniscience,
the patient is less likely to experience a misunderstanding as his respon-
sibility alone' and therefore an indication of his inadequacy in some
respect.

A Developmental Analog for the Process of

Self-Disclosure in Psychotherapy
Kohut (1977) in his seminal work appropriated the label "the psy-
chology of the self" (p. xv) for his particular approach to the study of the
self. Such study has a long history in psychoanalysis. Freud could be
said to have been the first "self" psychologist when he used the term ego
[das ich-literally, "the I"] as a synonym for self. Atwood and Stolorow
(1984) have given one of the most lucid definitions of the self in the light
of Kohut's contributions:
The self, from the vantage point of psychoanalytic phenomenology, is a psy-
chological structure through which self-experience acquires cohesion and
continuity, and by virtue of which self-experience assumes its characteristic
shape and enduring organization. (p. 34)
Self-experience refers to the immediate content of consciousness,
such as: I think this; I feel this; I fantasize this, I intend this. In this
instance, self-disclosure refers to revealing a particular content of con-
sciousness. Self as a psychological structure is an enduring trait of the
personality-a construction that is drawn from inference, abstraction,
and generalization over time, upon the basis of innumerable instances of
self-experience. The particular/momentary (Le., self-experience) and
the generalizable/enduring (i.e., self-as-structure) aspects of self are
interrelated, each forming the other. The self-as-structure shapes self-
experience by providing a schema through which self-experience is in-
terpreted and assimilated. Yet each new self-experience constitutes a
data base from which an evolving yet enduring representation of self is
constructed. In psychotherapy, both therapist and patient are construc-
tionists, privately constructing representations of the other through in-
numerable instances of mutual self-disclosure.
78 Lawrence Josephs

The sense of self originally arises in the context of the intersubjec-

tive matrix of the mother/infant dyad. Winnicott (1965) suggested:
"There is no such thing as an infant; meaning, of course, that whenever
one finds an infant one finds maternal care, and without maternal care
there would be no infant" (p. 39). The infant, though, is not a passive
participant in this process, for the infant is actively engaged in soliciting
the facilitating maternal response and evoking the mother's intuition
and empathy. Kohut (1971) coined the term "selfobject" to describe the
role which the object (i.e., the other) assumes in regulating the sense of
self so that the object is in effect a part of the self:
The expected control over such (self-object) others is then closer to the con-
cept of the control which a grownup expects to have over his own body and
mind than to the concept of the control which he expects to have over others.
(pp.26-27)

Stern (1985) saw the mother/infant dyad as engaged in an intricate

dance of mutual self-regulation through which they each discover the self
of the other. Self-disclosure, then, requires a self-regulatory other whose
function is to evoke, facilitate, receive, and mirror the self-disclosure, as
well as one who is open to revealing the self. Much of the technique of
psychotherapy is designed to facilitate the revelation of the patient's self.
Stern (1985) documented four domains of selfhood which emerge in
infancy: (1) the emergent sense of self; (2) the core sense of self; (3) the
subjective sense of self; and (4) the sense of a verbal self. The first three
senses of self are preverbal, experiential selves, whereas the verbal self is
a conceptual self, dependent upon the acquisition of language. Stern
described the emergent sense of self as "the experience of organization-
coming-into being" (p. 47) which characterizes the infant's sense of self
in the first two months of life. The infant as well as the later adult is a
constructionist, integrating and synthesizing new experiences in a pro-
cess of creative discovery. If it were not for the emergent self, life would
remain a disorganized and confusing array of disparate and discon-
nected events. In psychotherapy the patient's emergent self, usually
outside of awareness, is busily collecting the manifold experiences of the
treatment, gradually integrating the experiences into a coherent and
meaningful whole. The therapist's role, like the mother's, is to facilitate
this integrative process through the provision of what Winnicott (1965)
called a "holding environment" (p. 45)-a secure, consistent, and sup-
portive setting that allows for the unfolding of innate maturational pro-
cesses, processes that reflect the infant's unique temperament.
Stern (1985) describes the core sense of self as possessing a sense of
self-agency, self-coherence, self-affectivity, and self-history (p. 71). At
around two to three months of age, the infant for the first time gives the
impression of being a complete and integrated person in his or her own
Self-Disclosure in Psychotherapy 79

right. Yet these senses of self do not function with complete autonomy
but are dependent upon the mother's facilitating responsiveness: Her
enthusiastic yet non-domineering encouragement bolsters self-agency;
her consistency and reliability supports self-coherence; her affective at-
tunement and responsiveness evokes self-affectivity; and her continuity
over time supports self-history. The relationship with mother becomes
internalized in the form of what Stern (1985) calls "Representations of
Interactions that have been Generalized (RIGS)" (p. 97). When a RIG is
activated in the absence of the mother, the infant encounters an "evoked
companion" (p. 111). The analog in psychotherapy is that, over time, the
patient develops representations of experiences with the therapist as a
self-regulating other who in absence is reconstituted as an evoked com-
panion. Serving as a growth-promoting self-regulating other requires
more than a correct technique of management: a highly personal empa-
thic immersion in the experience of the other. Such an empathic immer-
sion invariably expresses and reveals some private essence of the self of
the self-regulatory other. Bollas (1987) suggested that each mother pos-
sesses her own particular idiom of mothering, an aesthetic of being that
becomes a feature of the infant's self so that "we learn the grammar of
our being before we grasp the rules of our language" (p. 36). Analo-
gously, the therapist's self-regulatory function is mediated through his
unique somato-affective presence; an individualistic sensibility that in-
tuitively guides his aesthetic of handling and being with the patient.
Thus the personal idiom of parent/therapist handling becomes trans-
lated into the internalized self-care system of the child/patient.
Between the seventh and ninth month of life, the infant develops a
subjective sense of self in which it is realized that "inner subjective
experiences, the 'subject matter' of the mind, are potentially shareable
with someone else" (Stern, 1985, p. 24). The infant at this point can sense
that others distinct from oneself possess a mind of their own in which
they are capable of sharing a similar experience with the infant. This is
the level of true intersubjectivity in which physical intimacy in terms of
a sensitive somato-affective presence give rise to psychic intimacy in
which issues of openness to disclosure versus privacy and inscrutability
become relevant. At this level the infant is not only eager to share its
own subjective experience but can begin to become curious as to the
nature of the private subjective experience of another. Intersubjectivity
at this stage is still predominantly preverbal-communication transpir-
ing through the medium of empathic affect attunement. The implication
for psychotherapy is that self-disclosure is very much mediated through
the quality and intensity of spontaneous nonverbal affective responsive-
ness. Since spontaneous affective responsiveness is to a significant de-
gree modulated by volitional control and therefore subject to a theory of
80 Lawrence Josephs

psychotherapeutic technique, there has been much controversy as to the

optimal level ~nd quality of emotional expression which the therapist
should encourage from the patient and allow for himself. A caveat,
though, in terms of establishing guidelines for therapist emotional self-
expression is that, however muted the intensity of affective expression,
the patient is likely to register the quality of the feeling and the degree of
self-inhibition in its expression. In addition, feigned affect attunement
(Le., pretending to share feelings) is likely to be registered by the patient
as non-genuine. Thus, many aspects of the intersubjective affective in-
terplay are beyond prescription.
During the second year of life the infant develops a sense of a verbal
self. Through the acquisition of language, the infant acquires a greater
capacity for symbolic thought. At this point the infant could be said to
begin the construction of an objective self-concept in which the self is
viewed from the perspective of others-possessing a unique personal
name, a particular gender, and a social status within the family. Consen-
sually validated language constitutes a common symbol system through
which subjective experience can be shared verbally. Psychotherapy, as
"the talking cure," has traditionally been conceptualized as a treatment
for emotional illness through verbal dialogue. As language becomes more
sophisticated, especially in the development of poetic devices, such as
metaphor, simile, metonymy, and symbolism, language gains tremen-
dous power to evoke vital emotional experiences. Nevertheless,
language can also have a self-alienating effect when the preverbal expe-
riential self is poorly or incompletely represented by words. After all,
not everybody has a well-developed capacity for a poetic use of lan-
guage, a use of language that can evoke experience that transcends the
words alone. Many patients live in a concrete experiential world, rarely
entering the realm of the imaginative, symbolic, or abstract (Josephs,
1989).
According to Stern (1985), "Language forces a space between inter-
personal experiences as lived and as represented" (p. 182). Stern noted
that the child learns very early on that one is accountable for what one
says, so that what one experiences but does not say is more deniable to
others, as well as to oneself. As a consequence, verbal self-disclosure is
suspect, since what one says one thinks, feels, and intends may be out of
touch with one's experiential self, which is denied. Whereas patient
verbal self-disclosure is subject to an intensive process of exploration
and analysis in the effort to link the most representative and evocative
words to the patient's experiential self, the therapist's verbal self-
disclosure is usually to be taken by the patient at face value, unless the
roles are reversed and the patient is given the freedom to question,
challenge, and analyze the therapist's verbal self-disclosure.
Self-Disclosure in Psychotherapy 81

Implications for Psychotherapy

The implications of self psychology for self-disclosure in psycho-
therapy will be illustrated through a clinical vignette. A single woman
in her late twenties who will be called Susan had initially sought treat-
ment after being rejected by a man whom she hoped to marry. The
rejection constituted a deep injury to her self-esteem and after about 1Y2
years of treatment her pride in herself had been restored. At that time
she decided to remain in treatment to work on a vague sense that she
lacked a depth of feeling in herself, and that even when she was aware of
her feelings, it was difficult to express herself. Susan could be aptly
described as "normopathic" (McDougall, 1985, p. 156), for she viewed
her life as unremarkably normal, average, everyday, and uneventful.
Although not particularly close to anyone, she never felt lonely, for she
believed it was just a matter of time that with a little bit of luck she would
find a suitable husband for herself. As a consequence of her normo-
pathic experience of her life, she felt she had little to discuss in sessions
and looked to me to inspire and guide her. When I remained passive in
that regard, there were long uncomfortable silences, after which Susan
would angrily complain of feeling bored with treatment. Yet when I
attempted to be more active in providing her with feedback, Susan
became indignant and defensive, accusing me of being overly judgmen-
tal, critical, and blaming.
In one session during which Susan complained of feeling bored and
resentful in regard to her slow rate of progress, she posed the question-
"Aren't you bored too?" to which I responded with the self-disclosure-
"1 feel frustrated." The ensuing discussion centered upon our difficulty
in getting past the seeming therapeutic stalemate. As the discussion
proceeded, Susan became increasingly defensive, indignant, and criti-
cal of me, as though she were under attack. I recognized that Susan had
experienced my self-disclosure and the ensuing discussion as a manner
of blaming her for the slow rate of progress, as though she were a will-
fully recalcitrant person. When I responded with an interpretation to
the effect that Susan felt blamed by me, she wholeheartedly agreed and
added that she had not been the one who was hypersensitive, but that I
had been the one who was hypercritical. In reflecting on this incident, it
occurred to me that in disclosing that I felt frustrated, I was revealing
only a partial truth. It was difficult for me to acknowledge what the
patient surmised, that in addition to feeling frustrated, I also felt bored
with her, and blamed her for being so difficult to reach. To say that I was
only frustrated and follow that up with a discussion of her difficulty
expressing herself seemed to be taken as implying that I saw myself as
some dedicated martyr, frustrated at not being able to help but seeing
82 Lawrence Josephs

the problem as residing solely within Susan rather than in the relation-
ship that developed as a process of mutual influence. It was to this
implied aggrandizement of myself at Susan's expense that she took
offense.
This vignette illustrates the double-edged nature of therapist verbal
self-disclosure. If we assume that therapists rarely consciously dissimu-
late in their verbal self-disclosure, it can also be surmised that they
rarely reveal more than a partial truth, and that what is left unsaid may
be as important as what is explicitly stated. Regardless of what the
therapist does or doesn't say about himself, the patient in registering the
therapist's somato-affective presence is developing some representation
of the therapist's experiential self to which the patient will compare any
verbal self-disclosure the therapist makes. When Susan asked me if I
was bored, it would have been transparently non-genuine if I denied all
negative affect, as though treatment was proceeding in some interesting
manner (i.e., a normopathic evasion). To have said "yes, I'm bored"
would have been wounding, since, after all, Susan was fishing for some
reassurance that she wasn't a totally superficial and boring person. In
responding, "I feel frustrated," I was attempting to acknowledge that
aspect of treatment which was an arduous task for both parties involved,
yet imply that however difficult a challenge, it was not yet a hopeless
situation. Nevertheless, the patient as interpreter of the therapist's expe-
rience (Hoffman, 1983) surmised that I was not only frustrated but bored
and blaming as well.
It would seem that the patient may be the best spokesperson for the
therapist's experiential self. After all, who can better speak for the
unique idiom of the therapist's way of being as conveyed in his somato-
affective presence than the patient, who has been the subject of the
therapist's best efforts to establish empathic rapport? Of course, the
patient is not always so articulate in describing his experience of the
therapist as a person, colored as it is by his or her own fears of psychic
intimacy. Much of the patient's response to the therapist's impact as a
person is expressed nonverbally, outside of the patient's awareness.
Thus, an important aspect of therapy is helping the patient become
aware of and articulate unconscious perceptions of the therapist. In recent
years this focus has been vigorously advocated by Langs (1976) and Gill
(1982). Curiously, although both analysts acknowledge the importance
of recognizing the plausibility of the patient's unconscious perception of
the therapist, rather than view it as primarily a product of transference
distortion, their attitude towards therapist verbal self-disclosure as a
means of validating the patient's perception is rather conservative.
A danger of therapist verbal self-disclosure is that it may foreclose a
thorough exploration of the patient's own perceptions of the therapist.
Self-Disclosure in Psychotherapy 83

When Susan asked if the therapist was bored, the therapist could have
inquired as to what about the therapist gave her the impression that he
might have been bored with her and what it would mean to her if the
therapist was indeed bored with her. Such a response could have helped
the patient get in better touch with her own intuition and develop
greater trust in her own perceptions. Foreclosing such exploration
through verbal self-disclosure could readily be taken by the patient to
imply that the therapist's verbal self-disclosure is to be honored as re-
ceived wisdom that must be accepted at face value. In so doing, the
therapist assumes an authority to define the objective nature of the
interpersonal reality that implicitly devalues the patient's perception of
the therapist in favor of the therapist's own self-perception. In the cur-
rent example, whether I said I was frustrated, bored, challenged, stimu-
lated, and so on would not alter one bit the validity of Susan's perception
of me as bored and blaming, no matter how discrepant with my own
self-perception.
Despite the potential pitfalls of therapist verbal self-disclosure,
there are dangers in failing to verbally disclose the self. For example,
Susan was quite sensitive to the distinction between the phrasings-
"You feel I'm criticizing you" and "When I criticized you, you felt at-
tacked." Although both statements convey a measure of empathy for her
feeling criticized, the first statement could readily be construed as im-
plying "You only imagine I'm criticizing you but in reality I'm not,"
whereas the second statement implies consensual validation, an ac-
knowledgment that the therapist can entertain the view that he had
indeed been critical, albeit unconsciously. For the therapist simply to
explore the patient's perceptions of the therapist, while withholding
comment as to whether those perceptions are congruent or incongruent
with the therapist's own self-perceptions, is to treat the patient as
though the patient were living in a world of illusion rather then engaged
in a real relationship with a flesh-and-blood person who communicates
his feelings and attitudes in innumerable nonverbal ways. For Susan, it
was not enough for the therapist to empathize with her feeling blamed,
for she required some validation of her sense of reality-that the thera-
pist had actually been critical and that she had not fabricated her feel-
ings out of some hypersensitivity to feedback. To withhold comment
lends a sense of unreality to such a situation. Her question, '1\re you
bored too?" is a form of reality-testing, so that to fail to provide some
self-disclosing response is to thwart her efforts at reality-testing.
Kohut (1984) suggested that at points of empathic failure and mis-
understanding, therapist verbal self-disclosure may be useful:
In a properly conducted analysis, the analyst takes note of the analysand's
retreat, searches for any mistakes he might have made, nondefensively
84 Lawrence Josephs

acknowledges them after he has recognized them (often with the help of the
analysand). (p. 67)

Empathic failure and misunderstanding is inevitable in psycho-

therapy, since no therapist is omniscient. No matter the scope of the
therapist's empathic comprehension, or the sincerity of the therapist's
empathic intent, therapist and patient remain two distinct persons with
different perspectives that can never become identical, although many
connecting bridges may be formed. Although Kohut advocated ac-
knowledging mistakes, he stopped short of recommending a disclosure
of the therapist's reasoning or feelings that led to the mistake. The ad-
mission of the mistake validates the patient's sense of reality in having
been misunderstood, but leaves ambiguous the intersubjective process
through which the misunderstanding developed. Perhaps some dis-
closure of the therapist's faulty reasoning or defensiveness may help the
patient grasp how the misunderstanding has come about. To fail to offer
some such explanation is to leave the patient mystified as to the process
through which the therapeutic dyad achieves harmony in intersubjec-
tive attunement or flounders in intersubjective misattunement. Despite
the therapist's admission of making a mistake, the patient is likely to
construe misunderstanding as a failing on his part as long as he lacks
any clear conception of how the therapist ended up off the mark. Simply
to admit mistakes remains in the absolutist psychology of right and
wrong, correct and incorrect; whereas to supply the patient with some
of the process behind the mistake brings the patient into the realm of
relativism in which events can be seen from multiple perspectives. In
the current example, for the therapist simply to have admitted having
made a mistake would have reinforced the absolutist psychology of
blame. Susan would have been relieved that I had accepted the blame so
that she didn't have to herself; but would still be stuck in the psychology
of looking for a scapegoat to be responsible for things that don't work
out. Further therapist self-disclosure could be of help in determining
how the therapeutic dyad came to such an impasse, allowing for a way of
looking at things in which no one is to blame.
Self psychologists are sensitive to the fact that patients are often ill-
prepared to consider events from any perspective external to their own,
and may therefore consider it an error in technique to introduce the
therapist's unique perspective. Although it is indeed crucial to demon-
strate to the patient that the therapist can see things from the patient's
point of view, once that fact has been established, patients are often
enough curious to see things from a new vantage point. From this per-
spective, the therapist's verbal self-disclosure constitutes a fresh van-
tage point that may help the patient to see the world from multiple
perspectives. When the therapist presents his verbal self-disclosure in
Self-Disclosure in Psychotherapy 85

an oracular manner suggesting omniscience, therapeutic dialogue will

be stifled, but if the therapist can present his verbal self-disclosure as
merely one limited perspective of one fallible human being, then the
scope of the therapeutic dialogue can be expanded through the intro-
duction of an additional perspective.
The therapist's theoretical perspective is of vital import in psycho-
therapy in determining the manner in which the patient's self-disclosure
is registered and represented. The self that the patient discloses in psy-
chotherapy is very much a product of the therapist's interpretive activity.
In the clinical vignette, Susan's conscious self-experience is that she feels
bored, is frustrated with the slow rate of progress, feels blamed by the
therapist, and is indignant. These self-experiences, as particular con-
tents of consciousness, do not reveal anything about Susan's self as an
enduring psychological structure, until the therapist supplies a theory
within which these self-experiences can be seen as deriving from an
ongoing organization of her personality. The two major listening per-
spectives through which psychoanalytically oriented therapists have
constructed their representations of the selves of the patients with
whom they work are the archaeological mode and the empathic mode of
listening (Josephs, 1988).
The archaeological mode of listening treats self-experience as a
manifest content to be de constructed into a latent content, whereas the
empathic mode of listening remains within the phenomenology of the
patient's self-experience. An archaeological analysis of the clinical
vignette would suggest that Susan's not knowing what to discuss in
sessions is an unconsciously resistant attitude that inhibits free associa-
tion. Her boredom could be construed as betraying a covertly defensive,
withholding, and hostile attitude for which she unconsciously expects
retaliation. The projection of her unconscious persecutory anxiety gives
rise to her acute sensitivity and defensiveness in regard to being
blamed. Yet to interpret that her negative transference to me is a sign of
the projection on to me of unacceptable aspects of herself would be
experienced as a dismissal of her self-experience of being an innocent
victim and as a still further example of being unfairly blamed and held
responsible for something that is not her fault.
A deeper level of archaeological analysis can be derived from the
theory of induced countertransference. Unconsciously, Susan could be
seen as recreating an object relationship in which I am assigned a partic-
ular role-to contain aspects of herself that she finds intolerable to bear
within herself. From this perspective, Susan would seem to draw me
into the psychology of blame in which one party plays the critic, while
the other is criticized. Her covertly withholding attitude could be seen as
an unconscious provocation of my hostility, to which she then responds
with self-righteous indignation.
86 Lawrence Josephs

Such a sadomasochistic power struggle would appear to recreate

and mirror her childhood relationship with her mother, whom she also
experienced as unfairly blaming and critical. Nevertheless, to challenge
her self-perception of being an innocent victim in suggesting that she is
unconsciously provocative would be experienced as blaming, of making
her take responsibility for my anger and criticality, as though my nega-
tive feelings were her fault. To interpret that she is recreating her rela-
tionship with her mother might soften the blame in displacing the blame
onto her mother but, since the implication is that she is identified with
her mother and like her, the sense of blame remains inescapable.
In summary, the self that Susan discloses in archaeological analysis
is a self in unconscious conflict, torn between an identification with a
persecutory and sadistic maternal introject and a victimized, masochis-
tic object of maternal abuse. Her conscious sense of self represents a
defensive compromise formation that denies her unconscious sado-
masochistic conflicts through a normopathic rationalization that justi-
fies her alienation from others, yet blinds her to her own fears of
intimacy. In treatment, whenever I failed to collude with her nor-
mopathic facade, the underlying sadomasochistic structure emerged
and was externalized in the therapeutic dyad's stalemate in debating
who was at fault and to blame for Susan's difficulties.
An empathic analysis of Susan's self-experience reveals a different
construction of her self as an enduring psychological structure. To take a
fresh look at her reported self-experiences-boredom, lack of a sense of
progress, feeling blamed, feeling injured by my blame which is seen as
unjust, and feeling justifiably angry with me-we can begin to explore
her phenomenological sense of self. From this perspective, it could be
hypothesized that there are enduring deficits in Susan's sense of a core
self, especially in terms of a lack of a sense of self-agency and self-
affectivity. Her boredom may reflect a lack of vitality affect. Not ex-
periencing herself as alive, vital, involved, attached, or engaged, she
experiences herself as painfully depleted and empty. She doesn't find
her own inner life interesting, stimulating, enriching, spontaneous, or
imaginative, so that she is chronically bored with herself. As an object to
herself, she experiences herself as disengaged and lacking in feeling.
Her sense of a lack of progress in therapy may be seen as reflecting a lack
of a sense of self-agency. Susan experienced herself as a reactive person
waiting for some external event or person to evoke a response from her.
She possessed little sense of spontaneous initiative, so that she re-
mained passive and inactive as long as there was no one to motivate and
move her. As long as nothing eventful occurred in her life, nothing
eventful could occur within herself. She had no sense that she could
make things happen of her own volition.
Self-Disclosure in Psychotherapy 87

Her sensitivity to criticism can be understood in terms of her lack of

a sense of self-agency. Experiencing herself as a basically passive, pow-
erless person, like a marionette on a string controlled by some external
agent, it seemed incomprehensible to her to attribute intentions to her-
self, even unconscious intentionality, given that she experienced herself
as someone lacking in intentions. Susan viewed other people as possess-
ing complex intentions to which she reacted; but her own intentions, in
her view, were no more complex than to comply with the demand char-
acteristics of the situation in which she found herself-in other words, to
meet the expectations of others. The sense of blame derived from feeling
held responsible as an agent for something about herself which she
experienced as outside her volitional control. Her anger and indignation
were reactive affects serving to extricate herself from the humiliating
sense of impotence that she experienced in being pressured to do some-
thing of which she felt incapable, that is, to be spontaneously related.
In the light of the empathic point of view, Susan's negative trans-
ference could be construed in terms of my failure as a self-regulatory
other. For Susan, just being in psychotherapy in which she was expected
to be reflective, introspective, and free-associate was like asking her to
speak a foreign language with which she had no acquaintance and no
way of gaining the necessary exposure for learning to occur. As a conse-
quence, the therapist in the role of self-regulatory other had to supply
the momentum, interest, and feelings so that Susan would feel that
therapy was not a futile exercise. Whenever I failed in this function,
Susan felt stuck, unable to proceed on her own steam. When I at-
tempted to explore her lack of a sense of self-agency and self-affectivity,
it was like reminding her and blaming her for some crippling defect over
which she possessed little control. To discuss these perceived deficien-
cies was taken as an expectation that she should be able to change, and
that it was readily within her power to change. Her defensiveness and
indignation then seemed a wholly justified reaction to my unreasonable
expectations.
Returning to the issue of patient self-disclosure, it becomes appar-
ent that the self the patient discloses to the therapist will be very much a
product of the therapist's interpretive activity. Is Susan revealing an
unconscious self conflicted over sadomasochistic power struggles, or is
Susan revealing an experiential self lacking in certain basic attributes,
such as self-agency and self-affectivity, or both simultaneously? Of
course, the self that the therapist believes the patient is disclosing is the
self to which he will respond and which will guide his interventions.
The patient then must learn how to contend with the therapist's view of
the patient's self, especially when it is discrepant with the patient's own
self-perception as it will inevitably be, given the limits of empathy. For
88 Lawrence Josephs

Susan, one arduous aspect of therapy was learning how to tolerate the
psychic intimacy of opening herself up to my perceptions of her, slowly
learning that in taking in some of my ego-alien views of her and making
them her own she need not lose or sacrifice her enduring sense of self-
sameness and self-continuity, and could perhaps enrich her sense of self
in the process.

Conclusion
Self-disclosure in psychotherapy is never received wisdom whose
meaning is transparent. Self-disclosure is always an intersubjective pro-
cess, and the self that the discloser transmits is rarely identical with the
self the listener receives, registers, and reflects back to the discloser.
This discrepancy is inevitable because empathy, our only tool for grasp-
ing the self of the other, is an imperfect instrument that can aim at
approximation but can never achieve absolute identity. Self-disclosure is
also an intrapsychic process in which the self is disclosed as an object to
oneself, in the vernacular, "getting to know oneself." The self that is
disclosed as an object to oneself is also always a construction rather than
a received wisdom that miraculously arises from the oracular pro-
nouncement of the unconscious mind. In conclusion, it should be re-
membered that each act of self-disclosure in psychotherapy is, as well,
an act of self-creation.

References
Atwood, G.G., & Stolorow, R.D. (1984). Structures of subjectivity: Explorations in psycJwanaly-
tic phenomenology. Hillsdale, New Jersey: Lawrence Erlbaum Associates.
Bollas, C. (1987). The shadow of the object: Psychoanalysis of the unthought known. New York:
Columbia University Press.
Gill, M. (1982). Analysis of transference: Vol. I. New York: International Universities Press.
Hoffman, 1. (1983). The patient as interpreter of the analyst's experience. Contemporary
Psychoanalysis, 19, 389-422.
Josephs, L. (1988). A comparison of archaeological and empathic modes of listening.
Contemporary Psychoanalysis, 24, 282-300.
Josephs, L. (1989). The world of the concrete: A comparative approach. Contemporary
Psychoanalysis, 25, 477-500.
Kohut, H. (1971). The analysis of the self: A systematic approach to the psychoanalytic treatment of
narcissistic personality disorders. New York: International Universities Press.
Kohut, H. (1977). The restoration of the self. New York: International Universities Press.
Kohut, H. (1984). How does analysis cure? Chicago: University of Chicago Press.
Langs, R. (1976). The bipersonal field. New York: Jason Aronson.
McDougall, J. (1985). Theaters of the mind: Illusion and truth on the psychoanalytic stage. New
York: Basic Books.
Self-Disclosure in Psychotherapy 89

Stern, D.N. (1985). The interpersonal world of the infant: A view from psychoanalysis and
developmental psychology. New York: Basic Books.
Winnicott, D.w. (1968). The maturational process and the facilitating environment. New York:
International Universities Press.
 III
Therapeutic Issues
 7
The Role of Implicit Communication in
Therapist Self-Disclosure
Jonathan M. Jackson

We may begin by distinguishing between two different levels of therapist

self-disclosure in psychoanalytically oriented psychotherapy. One is a sur-
face or manifest level, and it refers to facts, personal data, conscious experi-
ences of the therapist which he communicates in a variety of ways. The
other is a deeper, less obvious kind of disclosure, and it concerns the
communication of an individual's moral and social values, ways of relating
to others, mood and disposition, intellectual acuity, esthetic tastes, etc.
This second set of data comprises the kinds of knowledge one has of a
person by living or working on close proximity over a long period of time.
Although I will turn to a discussion of the surface level of self-disclosure
first, the reader may anticipate my view of the deeper disclosures. That is,
that any psychoanalytically oriented treatment must eventually turn to-
wards a consideration of the patient's perceptions of the therapist's deep
level disclosures, and that to avoid doing so denies the importance of a
major capacity of the patient and a major contribution to the therapist,
reciprocal aspects of the therapeutic relationship.

Traditional Views of Self-Disclosure

As a matter of technique, surface level self-disclosure has an un-
certain and uncomfortable place in the more classical conceptions of

Jonathan M. Jackson • Institute of Advanced Psychological Studies, Adelphi University,

Garden City, New York 11530.

93
94 Jonathan M. Jackson

psychotherapeutic work. It is not traditionally considered part of what

the therapist ordinarily does or ought to do in treatment. Rather, activ-
ities such as establishing and maintaining a secure therapeutic frame
(Langs, 1975), interpreting, clarifying (Strupp, 1969) and the like are
considered the rightful, legitimate domain of the therapist. All these
activities are focused on encouraging the production or understanding
of what the patient reveals and extending the patient's self-awareness. At
the same time, these therapeutic activities, focused as they are on the
patient, and based on the therapist's neutral stance vis-a.-vis the patient's
productions, make it possible for the therapist to retain a relative degree
of anonymity.
In this view, active self-disclosure by the therapist is usually seen,
in contrast to the patient's disclosures, as something to be approached
with caution, carrying a potential for muddying the lab of the patient's
uncontaminated transference. The therapist pursues a neutral position
vis-a.-vis the patient's life to allow as fully as possible for a representation
of conflictual material. The neutral setting is a communication from the
therapist that enables the patient progressively to communicate and
bring into relation to the therapist, feelings, thoughts, and memories
that were previously repressed. The point of the therapist's revealing
little of his attitudes or of his life is so that the patient may reveal more.
According to this position, a crucial intent of the positions of neutrality
and anonymity is that they will encourage an expression of the patient's
experience of the therapist that has little or nothing to do with the
therapist's actual behavior or attitudes. As the therapist is predomi-
nantly neutral in his dealings with the patient, the patient's attribution
of a complex of motives, feelings, and thoughts to the therapist is trans-
ferred from the patient's history, from the unconscious fantasies and
attitudes attached to significant people from the past.
This position, advocating the pursuit of neutrality and anonymity
for the sake of the transference, has many adherents. Loewald (1960), for
example, sees the analyst as a mirror who reflects the patient's uncon-
scious back to him and who maintains his mirroring properties by being
scrupulously personally neutral. The therapist is a blank slate and is
advised to remain so. Thus, the therapist remains uncasted, resistant to
the patient's effort to involve him in unconscious reenactment of the
past. Interpretation, according to Loewald, presents the patient with his
distortions in a new, objective relationship wherein the therapist's unin-
volvement in the patient's drama makes him available to the patient as a
voice of reality. What the therapist discloses, then, is his greater objec-
tivity, as opposed to his subjective bias. Thus, pursuing the position of
neutrality not only sets the necessary conditions for viewing the pa-
tient's experience as distorted by the past, but it also serves as a model
Therapist Self-Disclosure 95

for the patient to identify with, in the service of resolving his conflicts
with self and others.
Compared with Loewald's advocacy of the therapist's neutrality,
Stone (1961) relents somewhat, and allows for an attitude of benign
friendliness toward the patient. The aim of this attitude, however, is
consonant with Loewald's. That is, Stone wants to encourage an unfold-
ing of the transference (motivated from persistent and unmodified
wishes toward people in the past) that for some patients would be inhib-
ited by too much silence, self-reserve, and nonresponsiveness on the
part of the therapist. Benign friendliness is used to promote the patient's
transference, but not to interact with it. An example of neutrality mixed
with benign friendliness is seen in the advice of a colleague, who shied
away from directly addressing patients by name. She argued it could
imbue the transference with a warm (using first names) or cool (using
last names) tone and, in so doing, interfere with revival and subsequent
understanding of a patient's sense of warmth or coldness with his or her
early objects. She illustrated this by citing an instance of a patient leav-
ing a scarf behind in her waiting room at the end of a session. The
therapist ran after the patient and caught her attention visually just
before she passed through the elevator door, never once needing to call
out the patient's name. This technique was supported by another illus-
trating how one may telephone a patient without addressing him or her
by name either.
Kohut (1977) too is concerned with neutrality. He advocates a posi-
tion of empathic involvement wherein the therapist functions as a self-
object for the patient, facilitating a transference based on what the
patient's developmental level requires. The therapist's personal reactions
to the patient are seen as countertransferential to the extent that they
veer from the patient's needs for empathic resonance and prematurely
impose on the patient an awareness of the therapist as a separate person.
Responding too freely out of one's personal reactions (a break in empa-
thy vis-a.-vis the patient) is traumatic because the patient is not yet able
to function as a separate, differentiated self and so does not have the
reciprocal capacity to treat the therapist as a separate self. Neutrality in
this view is a matter of shielding the child-patient from the disruptive
realities of the parent-therapist. In this sense, the therapist fosters a
regressive relationship that is conceived by the therapist to be the
needed restorative one, as opposed to the actual one.
Prior to Kohut, Winnicott (1965) developed the notion of holding the
patient, a therapeutic function that keeps impingements from the outside
environment to a minimum. Impingements refer to a class of events, in-
cluding at times revelations of the therapist's personal reality, that dis-
rupt the patient's continuity of experience and thus create dissociative
96 Jonathan M. Jackson

trends in the personality. The therapist must remain concerned primar-

ily with his patient's needs and respond with the correct amount or kind
of environmental provision that promotes integration in the personality.
Winnicott did not develop the idea of empathy as explicitly as Kohut
did, perhaps because he believed it to be inherent, a natural, ordinarily
available capacity in the "good-enough" therapist.
Winnicott did believe, however, and in this respect his ideas are
clearly reflected in Kohut's clinical theory, that impingements were un-
avoidable. Thus, breaks in the holding environment ushered in breaks in
the patient's continuity of experience. These breaks were undeniable,
representative of the world out there, and they often provoke psycho-
logical health if properly timed and titrated. These breaks are not, how-
ever, at the center of Winnicott's or Kohut's theories. Rather, they are the
facts or the realities of the world, inevitabilities to which the patient
must eventually react. The therapist's role is to keep these breaks man-
ageable for the patient.
Greenberg (1986) points out that the concept of neutrality is unpop-
ular in many psychoanalytic circles because of its emphasis on inac-
tivity. Unfortunately, for some therapists, inactivity is seen as the way to
keep countertransference in check and thus remain nonjudgmental to-
ward the patient's values. This concept of neutrality is rooted in the
notion of the therapist who functions as an objective observer, rather
than as a participant observer. Greenberg argues for a new conception of
neutrality wherein the therapist's goal is to act in such a way that he
encourages the patient to see him as not simply identical with trans-
ference figures. This may often entail coming out from behind anonym-
ity, especially when the patient needs evidence to disconfirm his rigid
transference experience. At the same time, the therapist cannot expect
the patient openly to embrace new and mutative qualities in the thera-
pist, and he must tolerate the patient's insistence on the "reality" of his
transference. Thus, neutrality in Greenberg'S view is a position some-
where between the patient's transference expectation and the reality of
the therapist.

Special Events
According to the writers mentioned who represent a wide array of
theoretical schools, self-disclosure is viewed as a shift away from ordi-
nary therapeutic endeavors, to be utilized sparingly or not at all. When
it cannot be avoided, self-disclosure is often seen as evidence of uncon-
trolled countertransference which interferes with the patient's ability to
use optimally the therapeutic situation.
Therapist Self-Disclosure 97

Weiss (1975) addresses the issue of self-disclosure as it occurs acci-

dentally or involuntarily on the part of the therapist. Consistent with the
work of Tarnower (1966) and Katz (1978) he found that special events
such as chance meetings between patient and therapist, events such as
the therapist's illness, etc., actually intensified rather than inhibited
transference paradigms. This view contrasts starkly with the traditional
one that such breaks in the therapist's neutrality and anonymity can
distort or muddy the analytic work. Especially with patients who char-
acteristically keep the transference experience pale, special events can
provoke conscious awareness of previously private feelings about the
therapist. Weiss includes technical errors in the class of events that are
special or extraordinary, and these are caused by unchecked counter-
transference responses to the patient.
Viewing the therapist's pregnancy as a special event along the same
line as Weiss (1975), Fenster, Phillips, and Rapaport (1986) advocate a
modification in technique away from relative neutrality and toward self-
disclosure at the time of the pregnancy and soon after. In their studies,
they argue that the basic principles of psychoanalytic psychotherapy are
not violated by the disclosures that devolve from this kind of therapist
activity and, moreover, that the therapeutic process is often enhanced
by such breaks in anonymity. They report that patients are often stimu-
lated to produce previously unavailable material from their past and are
enabled to create new solutions to their conflicts during their therapist's
pregnancies. Perhaps mother is the necessity of invention.
Working earlier, Singer (1971) described the far-reaching effects of
telling his patients of his wife's serious illness when he was forced to
suddenly cancel his sessions. He observed from their reactions that
disclosing this information helped them to express a capacity to be
helpful and compassionate, and in so doing, made the patients' useful-
ness to another person become a realistic possibility perhaps for the first
time. In an obvious way, Singer's move departs from the relative neu-
trality and anonymity of classical psychoanalysis. In so doing, Singer
opened up the possibility that a legitimate goal of therapy might entail
the patient's discovery of his own helpful human responsiveness.
Singer's idea also goes beyond the traditional unilateral notion of the
therapist being of help to the patient and allows for the patient's capacity
to be of help to the therapist.

Progressive Views of Self-Disclosure

I now turn to a consideration of a deeper level of disclosure, the
indirect one which entails the therapist's mode of relating to others,
98 Jonathan M. Jackson

basic dispositions, values, and so on, which are communicated implic-

itly, rather than explicitly in the therapeutic situation. There are those
theorists who hold that anonymity and neutrality are false issues, and
that the therapist is in some respects not a blank screen, but an open
book. Accordingly, self-disclosure is seen not as a discontinuous or in-
frequent event, but one that is continuous and common.
The origins of this position may be traced at least as far back as
Ferenczi (1933/1988). Working within the theoretical framework of
abreaction, he recounted how some patients, despite their reexperienc-
ing in therapy of very intense trauma from the distant past, did not
improve as expected. While some symptoms did remit, others worsened
or became manifest for the first time. Unable, perhaps owing to his
unceasingly optimistic outlook, to accept that his method might not be
as useful as he had hoped, Ferenczi turned instead to a scrutiny of his
own unconscious communications to his patients. Listening to his pa-
tients' reproaches of him as unhelpful, selfish, and cruel, Ferenczi won-
dered whether he was guilty of some professional hypocrisy. That is, did
his promise to listen attentively and to work undauntingly mask an
unconscious aversion to features of the patients' personalities? And
were his patients, perceiving his unconscious withdrawal, responding
to that of which he as yet was only dimly aware? Ferenczi remained
concerned primarily with improving his technique to ease the way for
some patients whose past experiences of hypocrisy (verbal professions
of love with admixtures of physical and emotional abuse) were unwit-
tingly repeated in the therapeutic setup. What he did not see, as it
predates interpersonal notions of transference, were the broad conse-
quences of his view of the patient as perceptive of and responsive to the
therapist's unconscious communications and attitudes.
In perhaps the most fully elaborated presentation of the idea of the
patient perceiving the therapist without the latter intentionally disclos-
ing anything, Hoffman (1983) challenges what he calls the "naive pa-
tient" fallacy. The fallacy is
... the notion that the patient, insofar as he is rational, takes the analyst's
behavior at face value even while his own is scrutinized for the most subtle
indications of unspoken or unconscious meanings. (p. 395)

In Hoffman's view, and he cites the work of Gill (1982), Racker (1968),
and Levenson (1981) as supportive of his central notions, the patient is .
engaged in interpretive activity just as the therapist is. Hoffman posits
two ideas that form the basis for this conclusion. According to one idea,
the patient senses that the therapist's behavior is at best only partially
indicative of the therapist's entire experience. Thus, the patient is in an
ambiguous situation regarding the entirety of who the therapist is, and
Therapist Self-Disclosure 99

the patient's interpretative activity is necessary in order to construct a

relatively full and meaningful picture of what is on the therapist's mind.
Hoffman holds that while the picture of the therapist that the patient
construes may be accurate or not, there is no final expert on hand to
judge. The patient's picture of the therapist is an inference born partly
out of fact (the therapist's behavior) and partly out of (the patient's
selective attention or transference inclinations), and therapy concerns
itself with a full understanding of these two constituents of experience.
According to Hoffman's second idea about the patient's basis for
constructing the therapist's inner reality, the patient senses that his be-
havior influences the therapist's personal experience and activities as a
therapist. Put more simply, the patient knows he creates an atmosphere
by virtue of his being persistently and potently who he is, and that he
inducts the therapist into an emotional field of his own creation.
Thus, in this view, there are personal contributions made by each
participant. On the patient's part, he fleshes out the skeleton of the
therapist's anonymity and neutrality by constructing a full picture, and
he must interpret to do this. One source of his interpretations is certain
to be his past relationships with significant others. In this way the pa-
tient casts the therapist in a drama from the past. The therapist, if he is
willing to recognize his delimited hold on his anonymity and neutrality,
can experience experimentally these roles and respond with interpreta-
tions. Thus, the therapeutic relationship is an intimacy realized by vir-
tue of the patient's transference and the therapist's willingness to
respond. The patient intuits that the therapist's responsiveness (or lack
thereof) indicates something important about the therapist'S personal
experience of the patient. And the patient interprets this experience as
being based in part on the therapist's past relationships, moods, disposi-
tion, and so forth.
The blank screen concept, unlike the above notions of interactional
and implicit self-disclosure, sees the therapist as becoming known to
the patient only through discrete, intentionally orchestrated or acciden-
tal incidents. This concept in turn is rooted in a fallacy about the pa-
tient's inability to be perceptive about the therapist as long as the
therapist does not actively disclose information about himself. Even to
use the term self-disclosure implies that what is known to the patient
about the therapist is limited to what the therapist decides to disclose,
or to accidental breaks in neutrality. This is a variant of the "naive
patient" fallacy, holding that what the patient knows about the therapist
is controlled by the therapist's outward behavior, and that what the
patient otherwise presumes to know about the therapist is transference
distortion, subject to therapeutic scrutiny.
100 Jonathan M. Jackson

Characteristics of Neutrality-Seeking Therapists

If we examine the consequences of the traditional versus the pro-
gressive views of self-disclosure a bit further, we are left with another
conclusion. The underlying assumption behind the traditional thera-
pist's position is that he knows the reality, both in terms of what the
patient really needs (e.g., Kohut and Winnicott) and in terms of who the
therapist really is (e.g., Loewald, Stone) behind the screen. Thus, these
therapists presume they are in possession of a better grasp of reality and
a healthier psyche than their patients, capabilities that their patients
strive to attain. Proponents of neutrality who regard the therapist as the
one who decides when and in what form self-disclosure is an appropri-
ate deviation from the blank screen position, assume characteristically
what could be termed an authoritarian stance vis-a.-vis the patient. (See
Hirsch, 1981, for a full discussion of this issue.) Thus, it is the therapist's
choice whether and to what extent to disclose. The therapist is dispas-
sionate in his craft, not polarized, not ordinarily susceptible to being
pulled or coerced into enacting a role that complements the patient's
mind-set, having been inoculated against these enticements by virtue of
his training. He may be empathic toward the patient's efforts to pull him
into the action, but is supposed to remain nonporous as a matter of
technical necessity. An arbiter of reality, the traditional therapist might
disclose the truth to confirm the patient's sense of reality, to confer on to
it truth value, or else to designate it as false. Patients too may accept or
even prefer an impersonally neutral therapist, idealizable, hier-
archically superior because he holds the truth. This is evident when, for
example, a patient addresses the therapist as a representative of the
profession, an expert or a keeper of knowledge as opposed to an indi-
vidual with these or those particular qualities, these or those personal
strengths or weaknesses.
Paradoxically, those therapists who in their endeavor to downplay
authoritarian and hierarchical disparities between themselves and their
patient, frequently disclose personal facts, feelings, thoughts, etc., also
imply that their patients are naive. This is because in the view of these
therapists, the patient does not recognize his ability to understand who
the therapist is and must rely on the therapist's disclosures for a glimpse
behind the veil of anonymity. Although the thrust of liberal doses of
therapist self-disclosure comes out of the tradition of humanism (see,
for example, Jourard, 1971) it too often appears a gesture in which the
therapist emerges from his usual or expected position of neutrality and
anonymity.
What I am suggesting, too, is that the progressive therapist pre-
serves his neutrality and anonymity not in order to allow the trans-
Therapist Self-Disclosure 101

ference distortions to unfold unimpeded and uncontaminated by the

therapist; but to allow for the possibility that the patient will come to his
senses and know what he is as yet unwilling or unable to know. Erich
Fromm (1951) believed dreams were the place where patients were less
inhibited about what they knew and that dream images often repre-
sented knowledge that was disavowed in waking life. For Fromm, Hoff-
man, and a group of psychoanalytic psychotherapists I have labeled as
progressive, insight is a discovering of one's own ability to know. Fur-
ther, knowledge is not so much disclosed by the therapist, but recovered
by the patients.

References
Fenster,S., Phillips,S., & Rapaport. (1986). The therapist's pregnancy: Intrusion in the analytic
space. Hillsdale, NJ: The Analytic Press.
Ferenczi, S. (1988). Confusion of tongues between adults and the child: The language of
tenderness and of passion. Contemporary Psychoanalysis, 24, 196-206. (Originally pub-
lished 1933.)
Fromm, E. (1951). The forgotten language. New York: Grove Press.
Gill, M.M. (1982). Analysis of transference I: Theory and technique. New York: International
Universities Press.
Greenberg, J. (1986). Theoretical models and the analyst's neutrality. Contemporary Psycho-
analysis, 22, 87-106.
Hirsch, I. (1981). Authoritarian aspects of the therapeutic relationship. Review of Existential
Psychology and Psychiatry, 17, 105-133.
Hoffman, I.Z. (1983). The patient as interpreter of the analyst's experience. Contemporary
Psychoanalysis, 19, 389-422.
Jourard, S.M. (1971). The transparent self. New York: Van Nostrand Reinhold.
Katz, J. (1978). A psychoanalyst's anonymity: Fiddler behind the couch. Bulletin of the
Menninger Clinic 42, 520-524. New York: International Universities Press.
Kohut, H. (1977). The restoration of the self. New York: International Universities Press.
Langs, R. (1975). The therapeutic relationship and deviations in technique. International
Journal of Psychoanalytic Psychotherapy, 4, 106-141.
Levenson, E. (1981). Facts or fantasies: The nature of psychoanalytic data. Contemporary
Psychoanalysis, 17, 486-500.
Loewald, H. (1960). On the therapeutic action of psychoanalysis. International Journal of
Psychoanalysis 41, 16-33.
Racker, H. (1968). Transference and countertransference. New York: International Universities
Press.
Singer, E. (1971). The patient aids the analyst: Some clinical and theoretical observations.
In B. Landis and E.S. Tauber (Eds.), In the name of life-Essays in honor of Erich Fromm,
New York: Holt, Rinehart and Winston.
Stone, L. (1961). The psychoanalytic situation. New York: International Universities Press.
Strupp, H. (1969). Psychoanalytic psychotherapy and research. In L.D. Eron and R. Cal-
lahan (Eds.). The relation of theory to practice in psychotherapy. Chicago: Aldine
Publishing.
Tarnower, W. (1966). Extra-analytic contacts between the psychoanalyst and the patient.
The Psychoanalytic Quarterly, 35, 399-413.
102 Jonathan M. Jackson

Weiss, E. (1975). The effect on the transference of special events occurring during psycho-
analysis. International Journal of Psychoanalysis, 56, 69-75.
Winnicott, D.W. (1965). Maturational processing and the facilitating environment. New York:
International Universities Press.
 8
Transference, Countertransference, and
Therapeutic Efficacy in Relation to
Self-Disclosure by the Analyst
Esther Menaker

Very little has been written in the psychoanalytic literature about self-
disclosure-that is, self-disclosure by the analyst. In fact there is no
such category in the Grinstein Index of Psychoanalytic Writings. This is
not surprising since the very essence of the philosophy of classical psy-
choanalytic technique rests on the premise that the" cure" for the patient
depends on the creation of a "transference neurosis" within the context
of the psychoanalytic situation; and this in turn depends on the neu-
trality of the analyst. Neutrality in this case means a minimum of self-
revelation: no disclosure of opinions, values, or advice; no sharing of
personal experiences of biographical facts. The analyst is to remain a
nonperson in the name of fostering the development of the trans-
ference-that projection onto the person of the analyst of each individ-
ual's specific way of loving-or hating-which is the legacy of
constitution and early childhood experience (Freud, 1953). In the face of
a person's search for psychological help the therapist, according to clas-
sical psychoanalytic theory, is to remain neutral, that is, not interact with
the patient in any way other than to foster the uncovering of uncon-
scious impulses and to communicate such insights to the patient. This
procedure is founded on the premise that help or cure for the patient is

Esther Menaker - Postdoctoral Program for Training in Psychoanalysis and Psychotherapy,

Department of Psychology, New York University, New York, New York 10003, and Private
Practice, 20 West 77 Street, New York, New York 10024.

103
104 Esther Menaker

based on the lifting of the repression of unwelcome impulses-that is,

that the making conscious of previously unconscious wishes would ef-
fect change in an individual's personality. This premise is in turn based
on another preceding premise, namely, that neuroses or disturbances in
personality functioning are caused by repression of impulses, especially
sexual impulses. Neither premise, while describing some truth about
personality functioning, has been found empirically to be the exclusive
cause of neurosis or of disorders of the personality. It should follow,
then, that in the name of therapeutic efficacy, the cultivation of the trans-
ference is unproductive. The emphasis is upon the word "cultivation,"
for it is indeed impossible to prevent the development of transference
phenomena in any human interaction between two people, be it in
ordinary life or in the therapeutic situation. The way of loving or hating
which is so much a product of past experience becomes an intrinsic part
of an individual's personality and is bound to express itself in psycho-
analysis as well as in life in general. Freud was aware that transference
phenomena take place in life as well as in psychoanalysis; but he wanted
an intensification of transference feelings for the analytic situation and
to this end he advocated the neutrality of the analyst.
Many years ago, a patient whom I shall call Ruth, came to me
because her relationships with men were never consummated in a per-
manent relationship of any kind. She would have wished to be married
or at least to live with a man in a constant, companionable relationship.
But she always seemed to fall in love either with married or inappropri-
ate men; or to be unable to find men to whom she might be attracted.
She was a woman of about forty, not particularly attractive physically,
but she had a fine character, was highly intelligent, and had a lively,
outgoing personality that made up for her deficits in the realm of beauty.
She described her needs and wishes to me very clearly in our first meet-
ing, realizing fully that her social difficulties with men had to do with
inner conflicts of which she was not fully aware. As we concluded our
arrangements for her therapeutic work with me, I experienced an im-
pulse to tell her something of my life.
I was about 65 at this juncture. It was about a year after the death of
my husband, when I began to live with an elderly man who had been a
mutual friend of ours many years ago in our student days in Vienna. We
had re-met, were both free, were attracted to each other, and were un-
usually compatible. We decided to join our lives; and since I had a large
apartment, he moved in with me. My office and home were combined;
and patients, as they waited for me in a small anteroom near the front
door, occasionally saw family members coming in or out of the apart-
ment. I knew that sooner or later someone would see my new "room-
mate" entering or leaving the house. Contrary to classical psycho-
Transference, Countertransference, and Therapeutic Efficacy 105

analytic policy practiced by most of my colleagues in order-sup-

posedly-not to interfere with transference reactions, I wanted no un-
knowns, no mysteries about the major biographical facts and events of
my life. I told Ruth about my life arrangements of that time. Her reaction
is extremely important. After having listened intently, she turned to me
and said: "Then there's hope for me." "Yes, of course," I replied.
As I look back on the fact that I followed my impulse to reveal the
nature of my personal life at the time, if only in broad generalities, I
wonder what impelled me to follow my inclination-an inclination so
opposed to the therapeutic philosophy in which I had originally been
trained. Yet even that statement is not entirely accurate, for in my second
analysis with Willi Hoffer during my psychoanalytic student days in
Vienna, he himself was changing his personal life situation. He had
been divorced, and when I began my analysis with him, was living
alone and working in an apartment from which he was about to move.
When he gave me his new address, I asked about the reason for the
move. He told me that he was to be married soon and that he and his
wife were to move into the new apartment. He even told me who his new
wife was, Hedwig Schaxel-a nonmedical analyst who was a member of
the Vienna Psychoanalytic Society and a person whom I had seen at
meetings.
I expressed surprise at this forthright answer to my question, for I
had been indoctrinated to believe that any personal revelations on the
part of the analyst would interfere with the purity of the transference
reactions. "But," said Dr. Hoffer, "I believe that a patient has the right to
know the basic biographical facts of his or her analyst's life: whether he
or she is married or single, whether he has children and what his educa-
tional and psychoanalytic training consisted of." He presented this as if
he considered the biographical facts to be in the nature of credentials
whose meaning would differ for individual prospective patients, but
whose reality would give individuals the opportunity to make choices.
The simplicity and honesty of his remarks pleased me, and had the
therapeutic effect of creating trust. I never had the opportunity to dis-
cuss with Dr. Hoffer the extent to which his modifications of standard
psychoanalytic procedure were a part of a thought-out therapeutic phi-
losophy or derived naturally from his broad empirical experience with
human reactions which he was willing to affirm and take at face value. It
is significant that he never wrote on this theme; and that, in fact, most
classical analysts are timid about revealing what they regard as "trans-
gressions" of accepted procedure.
For me, the experience with Willi Hoffer liberated me at that time
[described in my memoir (Menaker, 1989)] from any tendency toward an
absolute faith in the validity of psychoanalytic theory and its technical
106 Esther Menaker

practices. Undoubtedly in my interaction with the patient described, the

nature of my analysis with Dr. Hoffer and his lack of fear of self-
disclosure (at therapeutically appropriate times; he had told me inci-
dents of his childhood, about his warm relationship with his father, a
country doctor, whom he often accompanied on home visits to his pa-
tients) reenforced my own inclination to share my life situation with my
patient. But to what end, one might ask? Not only to create an honest
atmosphere in which to conduct her analysis-although I consider this
extremely important- but also to make clear to her, longing for a rela-
tionship with a man, that even at my age this was possible.
Her answer about hope for herself confirms the effectiveness of my
self-disclosure. A number of years later she did indeed meet a man
within her professional circle with whom she fell in love and with whom
she has established a permanent and compatible relationship. Obviously
it was not merely my remarks about myself that enabled her to establish
a good relationship with a man. Much analytic work took place in the
intervening years. She learned a great deal that had been unknown to
her before. Her overattachment, yet ambivalence, to a father who was
inclined to be grandiose, and the way in which this affected her life
became clear, and her identification with him diminished. She came to
be less critical and more appreciative of a mother whom she had for-
merly regarded with predominantly hostile feelings. Such insights
played a major role in the changes that took place in her character and in
her behavior.
However, it seems important to emphasize that the analysis took
place in an atmosphere of nonjudgmentahiialogue about shared experi-
ences. We had much in common: our values and our familial back-
ground were similar. Our parents were professional people of Russian
origin. I understood the idiosyncrasies of that culture and could often
respond to her anecdotes with similar ones from my own background.
This created a powerful bond between us. Some might be inclined to say
that the special circumstances that derived from certain actual simi-
larities in our emotional experiences invalidate the assumption that self-
disclosure is of great importance. On the contrary: what is in this case
an actual similarity points to the importance of finding and expressing in
the interaction with patients those human commonalities which exist
for all of us, and to convey in these interchanges an affirmation of our
common human heritage and an expression of hope that the realization
of the patient's goals for his or her life-for which treatment was sought
in the first place-will be fulfilled.
Does such an exchange of experience and emotion between patient
and therapist preclude the development of the transference that is, in the
thinking of the classical analyst, the sine qua non of the psychoanalytic
Transference, Countertransference, and Therapeutic Efficacy 107

undertaking? I think not, for the simple reason that transference reac-
tions occur constantly in all our life situations, as I have already re-
marked, and as Freud himself stated. We carry with us the baggage of
our past which influences all our perceptions. It used to be called, in
academic psychological circles, our apperceptive background. The im-
print of past experience influences our perception of present-day events,
including the perception of people and their interaction with us. Fur-
thermore, the self-disclosure of the analyst is not-nor should it be-a
contrived technique calculated to further the therapeutic process. The
analyst unavoidably reveals him or herself in the course of interacting
with the patient through appearance, voice tone, way of expressing
herself, gait and body stance, to mention only a few of the cues that we
all pick up in the course of any human interaction. But self-disclosure of
the analyst in the analytic situation, as I understand it, is more than
that. It is a spontaneous empathic response to the patient's communica-
tion by sharing an analogous feeling or experience in the life of the
analyst. The purpose of the disclosure is to underscore for the patient
the fact that the analyst has understood the import of the communica-
tion and that he or she affirms the patient's reality. Sometimes, of course,
such an interaction goes awry. The analyst may not have understood, or
not have understood fully. But no matter; for the very willingness to
share experiences on the part of the analyst creates an atmosphere con-
genial to dialogue; and in the course of the subsequent interchange
greater understanding and trust is inevitably achieved and a closer bond
between the two participating individuals is created.
The fostering of an understanding bond between patient and thera-
pist in the name of arriving at a mutually acceptable understanding of the
patient's reality is, of course, the opposite of the Freudian approach,
which seeks to uncover a reality unknown to the patient-the repressed
and therefore unconscious, unacceptable instinctual impulses which
are seen as the cause of neurosis or of neurotic symptoms. A major
vehicle for this archaeological task is the analysis of the transference:
that projection of the patient's inner emotional life, complete with distor-
tions, upon the relatively nonparticipating personality of the analyst.
Thus a "truth" is arrived at that supposedly reflects hitherto unknown
feelings, wishes, and impulses. Once such previously unconscious im-
pulses are brought into awareness, they exist in the domain of the ego
and can be volitionally accepted or rejected, acted upon or not. The
possibility of choice ~as become part of the patient's psychological life.
The premise that underlies this approach to therapy is that the curative
factor in the analytic situation is the uncovering of the unconscious
(largely through free association, the analysis of dreams and fantasies,
and the analysis of the transference), making it known to the patient and
108 Esther Menaker

helping him or her to work through and assimilate the newly acquired
knowledge. The "real" or "actual" relationship of the patient to the an-
alyst is rarely of any consequence, since the analyst is viewed as an
outside observer, not as a participant in a relationship. This is the model
in broad strokes of the classical Freudian philosophy of therapy. It is
based primarily on a theory of conflict in which human development
takes place primarily as a struggle between drives that seek pleasure
(the release of tension) and superego constraints that represent the de-
mands of society.
A different view of development leads to a very different theory of
therapy-one in which the active role of the analyst plays a crucial part,
and in which the element of self-disclosure may contribute to the out-
come. It is in the approach of self psychology as it was begun by Heinz
Kohut that the patient's relationship to and interaction with the analyst
is decisive for change and/or cure. The analyst's way of observing as a
self psychologist differs from that of the Freudian analyst. For Kohut
advocates what he terms an introspective, empathic stance. In following
this directive the analyst is an active participant in the interchange with
the patient, observing the patient not as an object to be comprehended
from a distance outside oneself, but as someone whose emotions one
can take in even to the extent of momentarily losing oneself and merging
with the patient. It is through such empathy that the self-psychologist
hopes to make good those deficits in the patient's development that are
responsible for the maladaptations and unhappiness that brought him
or her to seek psychotherapeutic treatment. Self psychology rarely
speaks of neurosis or of conflict, but rather of arrests or deficits in an
individual's development due to familial experiences that failed to pro-
vide adequate nourishment for the child's developing self. A major as-
pect of the analyst's task is to provide that nourishment.
The rudiments of self-structure are given from the beginning of life
in the very nature of a child's constitution-in the way of responding to
the environment, the sensitivity to stimuli, and the reactivity of the
nervous system, for example. There are great individual differences in
the basic psychobiologic nature of individuals, for each person is
unique. Yet this uniqueness is further augmented by the specific nature
of the familial experience in the course of which the structure of the self
is laid down through processes of internalization. The child takes into
him- or herself the parents' very way of being: first the external traits-
the way of speaking, of walking, of gesturing; then the more internal-
the way of thinking, of relating to others, of feeling about oneself. Thus
the self of the child is structured.
Of course, the child is not a duplicate of his/her parents, for the
identifications have been added to the initial predispositions and a new
Transference, Countertransference, and Therapeutic Efficacy 109

and unique personality has been structured through his amalgamation,

as well as through the internalization of experiences and contacts with
individuals outside the family. Often identifications are rejected. Partic-
ular aspects of a parent's character or behavior are found objectionable.
Often, as therapists, we hear, for example, from young women: "I never
wanted to be like my mother," or "I have made up my mind that I would
never treat my child as my mother treated me." But all too often the
rejected identification is repressed only to appear in some distorted
form when the child-rearing situation becomes a reality. Whether identi-
fications are successfully assimilated into the self-structure or are re-
pressed, or are rejected out of hand, or are simply absent, leaving large
vacancies in the self, is determined by the nature of the parent-child
bond during the phases of development. Successful internalizations that
lead ultimately to a cohesive self-structure take place in a familial atmo-
sphere of love, of relatedness, of parental affirmation of the child. It is
loving respect for the growing, striving self of the developing child that
forms the nourishing soil for the integration of a self in the growing
individual-a self that can relate well to others, make emotional com-
mitments in close relationships, and enjoy a secure sense of self-esteem.
One day a psychologically sophisticated middle-aged man whom I
shall call Karl, who had been in treatment at various times in his life, and
with me for more than a year, came to his session in a discouraged
mood. He had been looking back on the history of his emotional life and
realized that he had never been able to make a commitment to a woman
that had any degree of permanency. He had had two unsuccessful mar-
riages and his current relationship was one to which he felt he could be
loyal only in a limited way. He wished very much to be able to love fully
enough to commit himself to a marriage. He feared that it would always
be this way, for while his various therapies in the course of the years had
provided him with considerable insight into the psychodynamics of the
emotional interactions among family members, they had not been able
to help him toward a full love relationship.
Knowing a little about the emotional limitations in his relationship
to his mother, and suspecting that there might still be aspects of this
relationship of which he was unaware, I began asking him about his
mother in greater detail. My patient began to describe a person who was
timid, uncertain, and unassertive in her relationship to individuals out-
side the home, and who was unfocused and detached in her relation-
ships within the family. She sounded unformed in her own personality
structure and unable to be totally committed to relationships-to her
children, to her husband, and to those outside the family.
It suddenly struck me that my patient's inability to commit him-
self to a relationship signaled a profound and completely unconscious
110 Esther Menaker

identification with a similar inability in his mother-one that he had

incorporated and that became a profound imprint that determined the
nature of his relationships to women. I communicated to him my hypoth-
esis that his own limitations in his ability to become attached in a pro-
found way to women might be the result of an identification with his
mother-with her inability to relate to others-in fact, with her detach-
ment and isolation.
I emphasize the word "hypothesis" because the manner in which an
insight is conveyed is of great importance, especially in relation to the
issue of self-disclosure. To hand down interpretations as absolute truth
is to present oneself as an autocratic therapist, even as an autocratic
individual. The authoritarian stance vis-a.-vis the patient is, to some
degree, the psychoanalytic legacy of its historical origins in hypnosis,
although, even in this connection, psychoanalysis distinguishes be-
tween the authoritarian and the persuasive maternal type of approach in
hypnosis. If, on the other hand, one is engaged as a therapist in a
dialogue with a patient-a dialogue that seeks to explore possible expla-
nations for a patient's character structure or behavior-in an egalitarian
atmosphere, one wins the patient's trust and reveals oneself as an empa-
thic person capable of precisely that kind of relatedness which the pa-
tient lacked in the course of development.
My conjecture about my patient's possible identification with a
withdrawn mother made a profound impression upon him. He could
scarcely believe that in the many years of therapy that he had experi-
enced, the possibility of this aspect of his personality development had
never been unearthed. He seemed relieved by the insight-by the
knowledge that he had been a victim of an unconscious unwelcome
introject that was his mother's way of relating to others. He was imbued
with some faith that this introject could be exorcised. He could become
his own person and discover his own way of loving.
Karl began his treatment with me in the reserved and somewhat
distant manner to which he was accustomed from previous therapies.
Gradually he began to respond to my somewhat casual manner. In the
beginning I noticed his surprise if I shared some of my experiences and
reactions with him. For example, we might recently have heard the same
concert, or have gone to the same art gallery. It would not be unusual for
me not only to hear about his reactions with interest, but to share my
own with him; I recall clearly an occasion when we spoke about an
exhibition of primitive art that he particularly enjoyed. It happened that
I had found this art form somewhat uncanny and I described to him my
hypersensitivity to any quality of eerieness in works of art or even
sometimes in natural scenes. I told him of a childhood experience when,
upon returning from school one afternoon, I had come unexpectedly
Transference, Countertransference, and Therapeutic Efficacy 111

upon a reproduction of the Mona Lisa. The picture which had just been
given to my mother by a neighbor was standing against a wall waiting to
be hung. I had been frightened by her strange enigmatic smile and ran
screaming down the hall to ask my mother: "Who is that Indian down
the ha1l?" Even as an adult and even after having seen the original, I
have never succeeded in feeling comfortable with da Vinci's supposed
mas terpiece .
Such small vignettes out of my own life, particularly out of my
childhood that revealed my own emotions gradually helped Karl to
experience his own feelings in a less muted form. My disclosures also
enabled him to perceive and experience me as a real person with
strengths and weaknesses, with tastes and values that sometimes coin-
cided with his own, but were sometimes quite different. What is thera-
peutically important is that my revealed authenticity helped him to
delineate and define his own.
But what of the transference, that supposedly therapeutic vehicle
through the analysis of which memories are to be recovered, repres-
sions lifted, insight gained? The transference both in life and in the
therapeutic situation, since it is an individual's way of relating to others,
occurs inevitably. Yet the classic analytic situation, by virtue of the an-
alyst's lack of participation, intensifies and distorts the projection of the
patient's emotions onto the person of the analyst. I am reminded in this
connection of a film that grew out of Brazelton's infant research which I
had the good fortune to have seen in 1977.
The researchers were studying mother-infant interaction. One
frame showed an infant of about nine months sitting in his high chair,
expectantly awaiting the arrival of his mother. When she entered the
room, smiling, cooing, and expressing her pleasure in being with him,
the little boy smiled, made gleeful sounds and body movements which
he could scarcely contain for sheer joy. The same child on another occa-
sion in which the setup was the same was confronted by his mother, not
with a smiling face but with a "dead" face in which no emotion was
expressed. The disappointed and frustrated child tried in every way-
by cooing and smiling himself, and by physically reaching out toward
his mother-to elicit a response from her. It was all to no avail. She
remained stony-faced. Finally, in frustration, the child began to cry, and
what began as a cry that expressed need, longing, disappointment, and
anxiety at being thus abandoned, turned into a cry of rage.
In the psychoanalytic situation, a similar scenario is recreated: the
childhood situation of the patient in which "The inevitable hierarchy of
the parent as protector but inevitably as final authority on the one hand
and dependent child on the other is repeated in the authoritative posi-
tion of the analyst and the inevitably submissive position of the patient"
112 Esther Menaker

(Menaker, 1988). Furthermore, the objective neutral stance and nonin-

teracting posture of the analyst which is recommended for classic psy-
choanalytic procedure is a contrived technique that artificially induces
extreme emotions in the transference-usually, and ultimately, rage-
which are then interpreted as products of the patient's neurosis. They
are in fact normal reactions to needlessly created frustrations in a situa-
tion in which one individual is asking another to be of help.
A patient's reaction of anger to the unempathic, detached behavior
of the analyst is not necessarily a regression to the infantile reaction to
frustration which I have just cited in my description of the film on the
infant research study. The parallel between the "dead" face of the
mother and the unresponsive so-called neutral stance of the analyst
illustrates the normal human need for social interaction.
The issue of self-disclosure on the part of the analyst is ultimately
bound up, as we have already seen, with the problem of the trans-
ference, which in turn reflects the analyst's theory of neurosis, as well as
the very philosophy of cure. To my mind, we are confronted here with
two separate views of neurosis and therefore with two different concep-
tions of therapy. I would like to emphasize the existence of two distinct
vantage points, both of which can playa role in the actual treatment of a
particular individual, but which are philosophically separate.
If, with Freud, we view neurosis as the result of the repression of
unacceptable sexual impulses which have been banished from con-
sciousness but which, from their existence in the realm of the uncon-
scious, continue to exert a deleterious effect on the personality of the
neurotic individual, then the goal of treatment becomes the lifting of
repression. It is important in psychoanalytic treatment to bring the re-
pressed impulses into awareness so that they can exist in the domain of
the ego and can thus be controlled by the ego. The use of free association
and the analysis of an intensified transference to the analyst thus be-
come the essential hallmarks of a classical psychoanalysis.
Freud attributes the intensification of the transference to the factor
of abstinence, i.e., the absence of the gratification of impulses. It is
precisely the lack of reciprocity in the classical analytic situation that
causes the libido to leave the world of reality, to regress to earlier stages
of libido development, and thus to reanimate the internalized imagoes
of early childhood toward which the impulses were originally directed.
To justify or rationalize this regression, the patient in the psychoanalytic
situation distorts by a process of projection his or her perception of the
analyst to achieve a correspondence between reality and the infantile
imagoes that reside in the unconscious. Making this process of distor-
tion conscious for the patient constitutes a major therapeutic goal of the
analytic process.
Transference, Countertransference, and Therapeutic Efficacy 113

The fact that the analyst is an objective observer, rather than a

participant, that there is no reciprocity in the relationship accounts for
the intensification of the patient's need for response-much as the in-
fant's response described above. The regression, the infantile response
is induced by the analytic situation and the analyst's technique of non-
participation. For the classic analyst, the return to the past is considered
of primary importance for the patient's cure or betterment. The trans-
ference phenomenon becomes a vehicle for unveiling what psycho-
analysis considers a convincing return to the infantile past that is
supposedly at the core of the patient's neurosis.
However, a different view of the genesis of neurosis would lead of
necessity to a modification, if not a complete change, in psychoanalytic
procedure. It is to Heinz Kohut that we owe a different perspective on
the origins of personality disturbances. For him there was a major line of
human development that differed from the development of the libidinal
stages which Freud had hypothesized. This was the development of the
self. The rudimentary self which is given at birth, develops further as
the child grows through processes of internalization-namely, through
the internalization not only of parental imagoes but of those parental
attitudes toward the child that were experienced in the interaction be-
tween the child and the parents. Kohut's emphasis in evaluating emo-
tional disturbances was heavily weighted in the direction of a concern
with self-esteem. Self-esteem in turn depends on the nutrients for self-
development which the child receives from the parents in the form of
mirroring or the opportunity for idealization.
For example, the pleasure that a child perceives in his mother's face
as she enjoys his or her activity, his accomplishments, in fact, his very
being, is internalized and becomes his own image of himself in which
he can take pleasure; his self-esteem is nourished and becomes secure.
In addition, if a parent-often the father-furthers the child's idealiza-
tion of him (or her), the growing self of the child is given another oppor-
tunity through an internalization of the ideal to support his growing self
and thus to achieve a good sense of self-esteem.
In familial situations that provide only a dearth of the nourishment
needed for the growth of a healthy, cohesive, and integrated self, the
child suffers emotional damage which is manifest in behavioral and
psychological maladaptation. Most often the result of such deficits is a
loss of self-esteem. This is true not only for narcissistic personality
disorders, as Kohut thought at first, but for all those disturbances of
personality that come to the attention of the psychoanalyst. The an-
alyst's therapeutic task then, according to Kohut, is not primarily to
uncover unconscious impulses and make them accessible to the con-
scious personality of the patient in the name of resolving conflict, but
114 Esther Menaker

rather to strengthen the self by making good those emotional deficits of

the patient's childhood that resulted in his or her failure to form a se-
curely consolidated self. This is achieved through the analyst's clear
affirmation of the person of the patient.
Otto Rank, who can be considered a forerunner of self psychology
and who thought that neurotics suffered from an inhibition in the func-
tion of "willing," due to a failure on the part of parents to accept the
child's will, also emphasizes the therapeutic effect of affirmation -in his
own terms, affirming the patient's will. Above all the analyst must not
further damage the patient's already fragile self-esteem. This can easily
happen if the analyst presents a cold, distant, authoritarian stance. One
of the dangers in the classic approach is precisely that the observing
objective (neutral) stance of the analyst can too easily become an atti-
tude of detachment, which inevitably lowers the patient's self-esteem.
The empathic stance of the psychoanalytic self psychologist, because it
is participatory, lends itself to interaction between patient and therapist
in which the therapist becomes the self-object for the structuring of the
patient's self. In the empathic mode, the purity of the transference, be it
mirroring or idealizing, need not be threatened, as in the case of tradi-
tional analysis, by the active participation of the analyst. It is the fact of
participation in the relationship to the patient that opens the way for self-
disclosure by the analyst.
When the analyst reveals something about him or herself-about
his life or experience-at a time and in a context that is appropriate
relative to the patient's communication, it becomes an echo, or an elab-
oration on the echo, of the patient's own experience, and thus serves to
cement a bond between the patient and the analyst, inhibiting processes
of projection and fostering identification. The analyst, since he or she
functions as a self-object for the patient, becomes authentic, and thereby
better serves to sustain and further the structuring of the patient's grow-
ing self. I would like to emphasize the factor of the authenticity of the
therapist in the treatment situation; for whatever the nature of a particu-
lar human interaction - be it between parent and child, teacher and
pupil, friend and friend, or analyst and patient-when the "other" is felt
as authentic, the delineation of the self is thereby furthered: differences
and similarities come into sharper relief and the self, as well as the
capacity for mature relatedness, is enhanced.
Self-disclosure cannot of course be random. It must be sensitively
attuned to the needs of the therapy; that is, to the particular needs of the
patient's developing self.
The question of countertransference is bound to arise in connection
with self-disclosure: does the analyst have an emotional need to reveal
himself or herself to the patient; and if the answer is yes, does this
Transference, Countertransference, and Therapeutic Efficacy 115

invalidate the procedure? Since we are speaking of an intense emotional

interaction between two individuals who undoubtedly have an effect on
one another, the answer to the first question may be affirmative. But if
the need is not quantitatively excessive, there is no reason to fear that it
will interfere with the patient's analysis. In an empathic atmosphere, the
needs of each individual as they interact with one another can be met
within limits. However, the patient's need for self-development in the
therapy must be of primary concern and the therapist must try to judge
when self-disclosure is productive and when it could become an obsta-
cle to the goal of treatment. In general, when self-disclosures are hon-
estly motivated by the analyst's desire to be helpful, even if they misfire
because of a failure in perfect empathic understanding, they can be used
productively in the analysis to demonstrate convincingly for the patient
the struggle between expectation and disappointment.
In conclusion, it would seem that self-disclosure lends itself much
more naturally to the empathic introspective stance of psychoanalytic
self psychology than to rigidly traditional psychoanalytic procedures.
There also remains the important question of the relation between the-
ory and technique. I have sketched the differences between the Freu-
dian and the Kohutian theory: the emphasis upon the repression of
libido, in the one case, and, in the other, that of the role of the developing
self and the deficits that may accrue to it. From these divergent positions
concerning the genesis of neurosis emerge the different technical pro-
cedures: that of the "neutral" stance in classical psychoanalysis and that
of the empathic introspection of the self psychologist. The important
issue is whether psychoanalysis will continue to see itself as an already
defined system of theory and practice-the practice of which inevitably
reinforces the theory, e.g., the neutral stance actually eliciting the extent
of the distortions in the transference-or whether psychoanalysis will
come to see itself as a theory open to being modified by clinical experi-
ence. The issue of self-disclosure and its efficacy is one such testing
ground.

References
Brazelton, T. B. (1977). Demonstration at NPAP's celebration of the twenty-fifth anniversary
of their acquisition of the Psyclwanalytic Review.
Freud, S. (1953). Dynamics of the transference. Collected Papers Vol. II, London: Hogarth
Press.
Menaker, E. (1988). Pitfalls of the transference. Paper delivered at the Adelphi University
Conference, How people change: Inside and outside therapy. October 1, 1988. (in press.)
Menaker, E. (1989). Appointment in Vienna. New York: St. Martin's Press.
 9
Self-Disclosure and the Nonwhite
Ethnic Minority Patient
Adelbert H. Jenkins

In this chapter I will concentrate selectively on certain issues involved in

self-disclosure in psychodynamic therapy with nonwhite ethnic minor-
ity people. It will be my basic position here that psychotherapy with
ethnic minorities can draw on principles and concepts that are applica-
ble to people generally. However, adaptations in conceptualization and
technique must be made for the important variations in class and culture
that exist in this country. Ordinarily the term "minority" in the United
States is applied to people of African-American, Asian-American, His-
panic American, and Native American or Indian descent. It is of course
not possible to do justice here to the range of issues that are pertinent to
these groups on so fundamental a concept as self-disclosure in therapy.
I will approach this material by limiting the discussion to a few
topics relevant to the theme of this chapter. I will be writing from my
greater knowledge of the literature on African-Americans, although I
will attempt to formulate what I have to say so as to make it broadly
relevant to nonwhite American groups. I will have in mind here the more
frequent context in which the therapist is white, although of course
much of this discussion will apply to nonwhite minority therapists
working with nonwhite clients as well. [For more detailed discussions of
specific groups, the reader is referred to the considerable amount of
emerging literature on psychotherapy with nonwhite minorities, some
of which is cited in the References at the end of this chapter. Such edited

Adelbert H. Jenkins • Department of Psychology, New York University, New York, New
York 10003.

117
118 Adelbert H. Jenkins

collections as those by Comas-Diaz & Griffith (1988); Dudley & Rawlins

(1985); McGoldrick, Pearce, & Giordano (1982); and Pederson (1985) are
good examples of this work.]

The Racial Context of American Society

Before proceeding to a discussion of factors that enhance self-
disclosure with the nonwhite ethnic minority client, we should note that
it may not be clear to some readers what the need is for a special chapter
on this topic. In attempting to answer this question we would have to
confront the dilemma posed by the very term "minority." While such a
term does properly characterize the political and social status to which
these people have been relegated, for the most part the usefulness of the
label "minority" stops there. Obviously there are considerable between-
group differences in the history and culture of these people and much
within-group variability among the individuals in these groups. In actu-
ality, the labeling of particular sets of people as "minorities" tells us
more about the dominant society that has coined the term than about
the people to whom it is applied.
Historically, Americans of European background came to the new
world with religious and cultural traditions that gave strong emotionally
laden connotations to the concept "white." The fantasies Europeans
developed about the darker-skinned people they came across in Africa,
Asia, and the Americas, helped them define their own sense of self
(Jordan, 1968). Thus, minorities have become the "Other," a dialectic
pole of self and identity for white Americans. American society has
needed to maintain its denigrated image of these Others in order to
sustain an acceptable sense of itself (Kovel, 1984). It has resisted allow-
ing colored minorities to rise too high in social status because that would
change some of the terms of self-definition for the dominant group.
These issues are relevant to our discussion here because mental
health service in general and psychotherapy in particular have been
carried out within this highly biased historical and social context
(Thomas & Sillen, 1972). Americans-including mental health workers-
are heirs to this way of looking at people of color, and the personal and
institutional practices flowing from such attitudes continue to have a
pervasive effect on personal and social life in this country. Though
nonwhite ethnic minorities have some of the familiar human problems
of living and, in addition, have had the special psychological stresses of
adapting to mainstream American society, it is not surprising that they
have not as readily availed themselves of traditional mental health
services.
Self-Disclosure and the Nonwhite Ethnic Minority Patient 119

If any client or patient (in this chapter I will use these two terms
interchangeably to describe the person seeking psychotherapy) is to be
helped (s)he must be enabled to talk freely and disclose or reveal aspects
of the self that may be seldom discussed or even thought about, but
which represent important limitations to that person's functioning.
With the minority client, even where the therapist gives evidence of
being well-meaning, (s)he may very well be seen as representing a social
structure that has been oppressive and judgmental and that seeks con-
tinually to work to its own advantage at the expense of the minority
individual (Bulhan, 1985). Thus, the American racial context puts an
added burden on the already difficult processes involved in self-
disclosure. Nevertheless, it is this writer's view that psychotherapy in
cross-ethnic situations can be useful to nonwhite minority clients and
the problems that impede such work can be overcome. With these
thoughts in mind I will focus the discussion on two issues: (1) engaging
the minority client in therapy; and (2) addressing language factors in the
cross-ethnic psychotherapy situation.

Engaging the Minority Client in Psychotherapy

The Problem of Attrition

Discussion about self-disclosure with the minority client is aca-

demic if that person does not remain in therapy. An important indication
of the fact that minority patients are wary about engaging in therapy is
the high attrition rate from psychotherapy for those minority persons
who seek therapy (Sue, 1977) and an underutilization rate for some
minority groups (Sue & Sue, 1987). In efforts to account for these phe-
nomena some writers have suggested that there are natural potential
pitfalls in interview contexts where the ethnic background or social class
of therapist and client differ, especially where the therapist is white in
these dyads (Banks, Berenson, & Carkhuff, 1967; Carkhuff & Pierce,
1967; Plasky & Lorion, 1984). For a time it was being suggested that
perhaps therapies emphasizing self-exploration were not appropriate
for the presumably nonverbal and nonreflective person of working or
lower-class minority background. (See Smith & Dejoie-Smith, 1984, for
a review of some of this literature.) However, other writers have sug-
gested, more wisely, I think, that if one is prepared to understand the
nature of the processes that go on in relationships where racial back-
grounds differ, a workable alliance can be established (Comas-Diaz,
1988; Gardner, 1971; Jones, 1978; Sue & Zane, 1987).
120 Adelbert H. Jenkins

Cultural Paranoia

Those writing about work with black clients have frequently spoken
about the reticent and rather suspicious manner with which these cli-
ents relate to mental health workers (Block, 1981). Ridley (1984) writing
about the "nondisclosing black client" points out the appropriateness for
black people of a kind of "cultural paranoia" (Grier & Cobbs, 1968), a
wariness regarding the behavior and motivations of white people. He
suggests that for the therapist working with a black client, the dynamics
of self-disclosure involve recognizing the difference for a given client
between "functional paranoia," based on maladaptive personal reac-
tions not related to race, and cultural paranoia. A "healthy cultural
paranoiac" -low on functional paranoia and high on cultural para-
noia-is more likely to be disclosive to a black therapist and nondisclo-
sive to a white therapist, in this view. A "functional paranoiac" -low on
cultural paranoia and high on nonracially based paranoid reactions-
would be nondisclosing to either a black or a white therapist. Ridley
goes on to suggest different strategies for addressing the client within
this conception.

Managing the Early Sessions

Credibility
As problems of attrition with nonwhite ethnic minority clients are
likely to be most acute early in the therapy encounter, what happens in
the initial sessions is crucial. Gibbs (1985) and Griffith and Jones (1979)
have suggested that one has the best chance of preventing premature
termination in therapy with the minority client if one works actively and
tactfully to engage the client from the very beginning of the contact. Sue
and Zane (1987) indicate that the therapist must be able early on to
establish his/her "credibility" and fulfill the client's expectation that
(s)he is going to get something from the experience.
The client may begin to self-disclose on the basis of a therapist's
"ascribed credibility," credit granted immediately based on his/her age,
training, gender, and perhaps ethnic background if it matches that of the
client. But the therapist must quickly move beyond this to work toward
an "achieved credibility" by showing skill in dealing with the client.
This accrues as the therapist is able to conceptualize the problem in a
way that is compatible with the client's belief system and helps the client
work toward goals and new ways of responding that are compatible with
the client's culture. Thus, to take an obvious example, in working with a
client from a traditional Asian-American background, it is probably well
Self-Disclosure and the Nonwhite Ethnic Minority Patient 121

to be quite cautious about advocating frank expression of aggression to

one's in-laws living in a traditionally structured family setting.
Sue and Zane (1987) suggest that another tradition from the Asian
culture, that of gift-giving, may be broadly relevant with minority cli-
ents. Such "gifts" do not refer to tangible material objects, of course, but
rather to such things as relief from negative feeling states; cognitive
clarification-providing some initial enlightenment about what seems a
hopelessly muddled situation; and "normalization," a sense that the
problem, though having features unique to the client, is like those that
other people have. Such interventions made early in the contact help the
client feel more like pursuing the difficult process of self-revelation and
self-exploration.

The Interpersonal Phase

Gibbs (1985) conceptualizes the dynamics in those early sessions in

more detail. She argues that black clients tend to take an "interpersonal"
stance in the psychotherapy initially rather than an "instrumental"
stance to the treatment process. This interpersonal phase, which proba-
bly lasts no more than two or three sessions, is one in which the client is
at first more attuned to the nature of the interaction with the therapist
than to the particulars of the presenting problem. Until (s)he is satisfied
with regard to the therapist's ability to be respectful of his/her ethnic
sensitivities, the client will be minimally self-disclosing. Gibbs de-
scribes a sequence of several "micro stages" in which the client assesses
the therapist'S ability to interact in a truly egalitarian way. If the thera-
pist handles the stages of this phase appropriately, an alliance develops
which enables the client to move into the more task-oriented, "instru-
mental" phase, in which the client begins to work on the more person-
ality-based problem that initiated the search for help. It is at this point
that the client becomes more genuinely self-disclosing. If the therapist
does not respond appropriately, the client may well leave within two or
three sessions. This perspective can probably be taken to have applica-
tion to clients from varying nonwhite groups.

"Agency" in the Minority Client

The Gibbs perspective is consistent with the idea that the minority
client, though troubled, and in some sense "demoralized" (Frank, 1973,
p. 314) as (s)he comes to therapy, nevertheless attempts to take an active
and purposeful role in the therapy situation. To some degree, these are
aspects of the exercise of "psychological agency" that minority people
122 Adelbert H. Jenkins

use generally to maintain a viable sense of self as they negotiate life in a

hostile society.
As I have suggested elsewhere (Jenkins, 1982, 1989) the term "psy-
chological agency" characterizes a broadly human capacity which mi-
norities have used to survive in America. This perspective draws on a
specific and well-articulated approach to humanistic psychology
(Rychlak, 1988). Key principles in this approach are: (1) subjectively held
intentions and purposes are a primary though not exclusive motivating
factor in human behavior; (2) "dialectical" thinking, the ability to fash-
ion alternative conceptions of life circumstances is often used by people
to circumvent negative situations; and (3) human mentality is actively
structuring as it approaches experience and "constructs" the "reality" it
considers to be meaningful. This framework is further enriched by in-
cluding the notion that a lifelong striving for effective and competent
interaction with the environment characterizes human behavior (White,
1963). Through the exercise of these features of psychological agency,
many nonwhite ethnic minorities have survived their oppressive experi-
ence in America by bringing to life conceptions of their competence that
have been at (dialectical) variance with the judgments that the majority
society has made of them.

Agency and the Sense of Self

One way of describing the subjective sense of this agency in the

person is by the concept of "self." From this introspective view, self is the
sense of orientation or identity that guides a person's life choices. The
notion of self also embodies the sense of authorship of one's thoughts
and actions. Much of an individual's activity in life is oriented toward
maintaining a sense of competence or self-esteem (White, 1963; Basch,
1988). Of course psychodynamic theory holds that important aspects of
an individual's agency are not in awareness, and some initiatives that
(s)he seeks to carry out stem from unconscious thoughts and feelings
that are maladaptive in their effect. One of the fundamental purposes of
enhancing self-disclosure in therapy is to help individuals become more
aware of the disavowed scope of their agency and thus gain more control
of their lives (Schafer, 1978, p. 180). This is as true for the nonwhite
minority individual as for anyone. Persons who are freer from emotional
disabilities are more able to act in the world and join with others to bring
about social justice.
Racism and ethnic prejudice are assaults on these healthy self pro-
cesses. The average ethnic minority person is able to withstand the
buffeting of a hostile society, at some cost in personal energy, by pursu-
ing competence strivings. Basch (1980), writing from the perspective of
Self-Disclosure and the Nonwhite Ethnic Minority Patient 123

modern self psychology in psychoanalysis, argues that patients coming

to psychotherapy bring the hope that they will be able to further the
development of important aspects of their self-esteem that were ham-
pered in the course of their living. Unconsciously they hope to be able to
use the therapist as a kind of "selfobject" (Kohut, 1977), a person who
will respond in ways that meet the specific needs of the developmentally
weakened self. As noted, when the minority person acknowledges the
need for psychological help, before (s )he can make use of the therapist in
this way, (s)he must try and be certain of what kinds of attitudes the
therapist brings from the larger society.
The added distrust that the minority client brings is not necessarily
"resistance" generated by the processes of the "instrumental" phase
(Gibbs, 1985; Jenkins, 1985). The minority client's special scrutiny of the
therapist early in therapy and his/her concerns about the therapist's
credibility involve some of the same processes of self-enhancement and
self-assertiveness (s)he has had to use to adapt to the larger society.
Research suggests that poor and minority clients are very sensitive to
the presence or absence of "egalitarian" attitudes in the therapist
(Lerner, 1972; Ross, 1983). Clearly the therapist's task is to be open to this
scrutinizing activity if (s)he is to be taken as an ally in the minority
client's efforts to remobilize hislher effectiveness.

Language and Psychotherapy

A more specific set of concerns with respect to self-disclosure by
minority clients derives from the importance of language in psycho-
therapy. Levenson (1983, p. 143) suggests that, in general, the patient
coming into psychotherapy may be described as suffering from a kind of
"semiotic defect" in which, as a result of a history of distorted commu-
nication patterns with significant others, (s)he is unable effectively to
symbolize in words the meaning of important aspects of past and pre-
sent experience. From this writer's perspective, such a defect constrains
the individual's exercise of his/her agency.
In focusing on the centrality of the construction and communication
of meaning in psychotherapy, Levenson knowingly touches on an issue
that is at the core of being human. Developing the capacity for language
during growth gives the individual a powerful tool for fashioning the
self. In all cultures, language is a preeminent means for shaping and
framing intentions, and hence is at the heart of the exercise of one's
agency and effectiveness in the world. It is also critical to the sense of
being a participant in an ethnic heritage. To speak a language, said the
psychiatrist Frantz Fanon (1967), "means above all to assume a culture"
124 Adelbert H. Jenkins

(p. 17). Language processes are at the heart of the therapeutic enterprise,
of course, and almost by definition are fundamental to issues related to
self-disclosure.

The Therapist's Skill: /JLinguistic Competence"

The importance of language in psychotherapy poses a particular
kind of challenge to the dynamic therapist with any patient. In addition
to creating a genuinely accepting atmosphere, the therapist's task is to
understand the cognitive and, especially, the affective meaning embed-
ded in the patient's speech. Psychodynamic theorists believe that this
requires exercising the therapist's empathic abilities (Korchin, 1976,
chap. 7; Jones, 1985). From Marshall Edelson's perspective (1975), such a
skill depends to an important degree on the therapist's "linguistic com-
petence": "the internalized knowledge of language that is possessed
without conscious awareness of it or even the ability to explicate it ... "
(p. 27). This is so even where therapist and patient are from the same
language community.
A further particular challenge for the psychodynamic therapist
stems from what I would call the "dialectic" quality of human symboliz-
ing capacities (Jenkins, 1988; Rychlak, 1979). Here this refers to the fact
that people (often unconsciously) intend to convey alternative, even
opposite, meanings with the same word or image, thus giving a rich
complexity to verbal productions and fantasy life. This makes a patient's
statements about a particular problem ambiguous on the surface. (This
was nicely exemplified by the patient of hysterical character makeup
who entered this writer's office in her overcoat one cold winter day.
Seeing the window temporarily open so as to air out the overheated
room, she stated firmly, "I'm not getting undressed until you close that
window!") The therapist's task is to help the patient to "disambiguate"
his/her utterances so that (s)he can get better control over what is being
experienced (Edelson, 1975). Edelson continues this line of thought:
What we call "intuition" in the psychoanalytic process may be an end prod-
uct of the psychoanalyst's disciplined preconscious decision to permit him-
self to hear all the possible meanings of the analysand's language, no matter
what particular meaning seems dictated by an immediate context. (p. 23)

Sociolinguistic Issues in Psychotherapy

Because language issues are important to self-disclosure, problems
are likely to arise where patient and therapist do not share the same
Self-Disclosure and the Nonwhite Ethnic Minority Patient 125

communicative style. The language disparity could occur either at the

level of dialect differences or in differences in the mother tongue that
each has learned to speak. As Russell (1988) notes in his excellent recent
review of issues related to language and psychotherapy, language dif-
ferences can affect the client's perception of the similarity between the
therapist and patient, and this in turn can affect the patient's readiness
to self-disclose, or even remain in therapy. The therapist's linguistic
style can also affect his/her credibility in the patient's eyes (Russell,
1988). Although manifest structural differences in language between
speakers can obviously complicate the communication process, perhaps
even more important are the "sociolinguistic" aspects of speech in the
therapy situation. Such concerns have to do with language "as a social
and cultural phenomenon" (Trudgill, 1974, p. 32).

Language as Status Marker

One of the problems for the self-disclosure process in psycho-

therapy is that, in the larger society, speech differences are habitually
used as a status marker for separating people into categories of worth
(Trudgill, 1974; Williams, 1970). In our society, the prevailing view tends
to be that all language forms that deviate from the standard represent
language deficits-a failure to have learned to speak properly. Even
more, those who speak a nonstandard dialect are seen as being inferior
and not fully civilized. Fanon (1967) takes note of this in his caustic
comments about the French attitudes toward colonials:
The Negro of the Antilles will be proportionately whiter-that is, he will
come closer to being a real human being-in direct ratio to his mastery of the
French language. (p. 18)
Yes, I must take great pains with my speech, because I shall be more or
less judged by it. With great contempt they will say of me, "He doesn't even
know how to speak French." (p. 20)

Such a way of thinking certainly characterizes the predominantly mono-

lingual mainstream American society. It is a part of that biased milieu
mentioned earlier in this paper that can affect the quality of the thera-
peutic interaction.

Suitability for Therapy

One of the effects on therapy of pejorative attitudes toward lan-
guage difference is that it probably contributes to the tendency to judge
the speaker with a different language background as being more disor-
dered and/or generally less suitable for the expressive psychotherapies
(Geller, 1988). Apart from there being little empirical evidence to support
126 Adelbert H. Jenkins

this notion, it seems wrong in principle. Recognizing that language is

crucial to the full development of a person in any cultural setting, to
treat some groups of people as if words don't ordinarily mean much to
them is almost to consider them less than human. As Marshall Edelson
(1971) notes, "a scarcity of language resources ... [and the] inability to
symbolize emotional, physiological, and sensory experience is not inci-
dental to psychological illness but may in fact doom an individual to it"
(p. 119). To deny a person the opportunity to overcome personal "semio-
tic defects" (Levenson, 1983) within hislher own idiom in therapy would
perhaps be tantamount to abandoning the patient "to a life of sleepwalk-
ing in a twilight zone of quasi-consciousness, in which he [would have
to] depend for relief of his pain solely upon the efficient manipulation of
his body and his environment" (Edelson, 1971, p. 119).
Russell (1988) suggests that while many therapists are able to ward
off the blatant American stereotypes associated with ethnic characteris-
tics of nonwhite persons, particularly if these clients are standard En-
glish (SE) speakers, these therapists are much more vulnerable to the
culture's attitudes toward people whose dialect is not standard. Thus,
Russell asserts that no matter how well-meaning the therapist is, unless
(s)he has considerable experience with a nonciinical sample of the lan-
guage group from which a given client comes, the chances are great that
the clinician will misconceptualize the nonstandard English (NSE)
speaking client. Russell suggests that, among other things, the therapist
should be ready to call on a knowledgeable consultant in working with
such persons. (The need for such help is particularly likely when the
clients are depressed, acting-out, lower-class black male adolescents, an
especially resistive and nondisclosing group (Gibbs, 1988; Paster, 1985).

Self-Disclosure to Oneself
It is not only that subtly pejorative attitudes on the therapist's part
stifle revelation to another person; an important intrapersonal process is
shut off as well. Self-disclosure involves not only communication be-
tween persons, it involves the individual's disclosing hidden or unar-
ticulated aspects of experience to himself/herself. Citing a clinical
example, Basch (1988) reports having commented to a patient who de-
scribed himself as not being "much of a talker," that the problem wasn't
so much his inability to talk to other people. The primary difficulty was
"that you can't talk things over with yourself inside your head. Without
words, it's hard to think things through, to consider different possi-
bilities" (p. 230). The opportunity to develop new labels and new con-
structions of past and current experience allows the person a changed
way of "coming at" the world.
Self-Disclosure and the Nonwhite Ethnic Minority Patient 127

Some Dynamics of Language Difference in Therapy

That which smothers open communication strikes at the very heart
of the healing process in therapy. This is made even more complex where
there are issues of language difference between therapist and patient.
Some writers suggest that such issues have implication for technique in
the therapy situation.

The "Language Barrier"

Clinical experience with bilingual patients suggests that when psy-

chotherapy is conducted in the language in which the patient is less
fluent, the person's ability to express affect is often hindered by a kind of
"language barrier" (Marcos & Urcuyo, 1979). In such circumstances, the
patient may show considerable emotional detachment from material
being discussed, leading to a kind of vagueness in the affective experi-
ences described, and an inability to benefit from catharsis and abreac-
tion in therapy. Marcos postulates that, for one thing, a person speaking
the language in which (s)he is less proficient, tends to go through a
special encoding and translation process which focuses the person more
on how (s)he is speaking rather than on what (s)he is saying. The speaker
becomes more concentrated on the cognitive and linguistic aspects of
the communication, to the detriment of the affect involved (Marcos,
1976; Marcos & Urcuyo, 1979).
Rozensky and Gomez (1983) point also to the fact that the speaker's
subordinate language is usually learned at a later stage in personality
development than is the first language or the "mother tongue." Thus
many important developmental experiences are not as readily available
to the patient in verbal form when the therapy is conducted in the pa-
tient's second language. From a psychodynamic perspective, "Therapy
which uses the second tongue as the main form of communication may
suppress the mother tongue and the affective experiences tied to it"
(p. 154). Thus, when warded-off material emerges in therapy, it "may not
accurately reflect the experiential aspects of the original events" (p. 155).
Some bilingual persons have native proficiency in both languages.
Even here there can be language-related problems in the therapy. Where
these persons have learned each language in a different cultural context,
they may "operate parallel encoding mechanisms, each with its own
stream of associations between message words and events in the idea-
tional system" (Marcos & Urcuyo, 1979, p. 334). This separation in the
patient's intrapsychic experience may extend to the point of a rather
deep-seated duality in the sense of self, and such patients may "feel and
perceive themselves as two different persons according to the language
128 Adelbert H. Jenkins

that they speak" (p. 335). These patients do not necessarily come into
therapy for identity conflicts related to language, but as therapy pro-
gresses, problems come to light that sometimes reveal a number of
concerns regarding ethnicity and acculturation.

Bidialectic Speakers and "Code Switching"

Nonwhite minorities in the U.S. often come from bidialectic, if not
bilingual, social backgrounds and contexts. That is, even if they have a
workable command of SE for use in more formal social situations or with
relative strangers, they may use a nonstandard dialect or their "mother
tongue" in informal or more intimate situations (Gumperz & Her-
nandez-Chavez, 1972; Kernan, 1971; Russell, 1988). In linguistic terms,
they may engage in "code switching" in their daily lives. Jenkins (1982,
Chapter 4) has suggested that in spite of its controversial status Black
Nonstandard English or "Black English" is a means that African-American
individuals have of "coming home" to their own culture, as it were, even
though they may be full participants in many aspects of the broad Amer-
ican social scene. The command of the dialect is a way of keeping alive
the ethnic roots that have nurtured them.
Ideally, as clients delve into unresolved conflictual issues in therapy,
they would feel comfortable in expressing themselves in NSE to capture
the full impact of a feeling or experience they are struggling with. How-
ever, Russell (1988) asserts that this development in therapy does not
necessarily come easily, even once the client has moved into the "instru-
mental" phase of therapy (Gibbs, 1985). Clients who are comfortable in
both SE and NSE, and accustomed to using SE in more formal situations,
are prone to match the therapist's SE style. Such formality is likely to
lead to greater restriction of personal information and lowered emo-
tional expressiveness on the client's part. Russell suggests that to cir-
cumvent this, the therapist might explore with the patient who the
people are with whom the patient shares more intimate information,
and what the context is in which (s)he does so. This discussion should
also begin to include exploration of the differences the client feels in
talking with the therapist about intimate things. From these kinds of
efforts an atmosphere ideally develops in which the patient begins to
feel encouraged to use in therapy the style that allows greater self-
disclosure and thus enhances the processes that are fundamental to
successful self-exploration.

Language Switching
In some instances, with bilingual patients, the use of "language
switching" is advocated, that is, explicitly encouraging the client to
Self-Disclosure and the Nonwhite Ethnic Minority Patient 129

discuss or label in the mother tongue a troubling conflict that emerges in

therapy (Marcos & Urcuyo, 1979; Rozensky & Gomez, 1983). Such a
strategy can presumably help clients overcome the detachment in their
description of emotional experiences, or facilitate gaining access to early
developmental issues that may be central to a key conflict. Rozenskyand
Gomez (1983) present several illustrative case examples. Even when the
therapist does not share the patient's bilinguality, encouraging the client
to describe the essence of an experience or feeling in the mother tongue
and then discussing the meaning with the therapist may open new
avenues of self-exploration and even be enhancing to the relationship.
It is acknowledged that selective use of this technique is called for
in the context of an evaluation of the patient's language status. At times
it may be more adaptive to encourage the patient to use the second
language to defend against being overwhelmed by an affective issue
(Marcos & Urcuyo, 1979; Rozensky & Gomez, 1983). The degree to
which the client's language status affects the ability to gain access to his/
her emotionality in therapy in the second language depends on a variety
of factors, such as the relative extent to which each language is used in
the patient's daily life; the age at which the second language was ac-
quired; and how emotionally expressive each of the two languages is
(Rozensky & Gomez, 1983).
The overall point here is that with many nonwhite ethnic minority
patients there will be the likelihood of some language-related dynamics
both from the patient's as well as the therapist's side that will affect the
atmosphere for self-disclosure. A patient's NSE dialect or native tongue
is an important tool of self-assertion and an important aspect of self-
identification. The therapist'S sensitivity to that language is a concrete
example of wanting to understand the patient on hislher "own terms."
Russell (1988) goes so far as to suggest that
Many of the typical problems identified in work with low-income and minor-
ity clients (not being verbal, failing to self-disclose, and looking for quick
solutions and direction as opposed to introspection) can at least be partially
explained by language-related dynamiCS. (p. 64)

Therapist Self-Disclosure
Much of the discussion in this chapter has pointed implicitly to the
complementary issue regarding self-disclosure, namely self-revelation
by the therapist. Again, much could be said about this topic, but we will
have to confine ourselves to a few points here. Humanistic therapists
write of the need for "genuineness" in the therapeutic encounter, which
could include disclosure by the therapist of personal feelings or history
130 Adelbert H. Jenkins

(Rogers, 1957). Traditional psychodynamic therapists are likely to be

more reticent about frank self-revelation. As an "interpersonal para-
digm" (Gill, 1983) begins to gain more support from various quarters
within the psychodynamic perspective (Levenson, 1983; Luborsky,
1984; Strupp & Binder, 1984), it is becoming clearer that it is impossible
for the therapist not to disclose aspects of himself/herself, even while
attempting to be neutral.
Harking back to our earlier discussion in this chapter regarding the
person as active agent, we must recognize that the observation process
in any interpersonal situation is a two-way street. The patient is actively
observing the therapist and bringing to this observation his/her typical
way of constructing images of other people and relationships. Levenson
(1983) cites an example from Ralph Greenson:
a patient points out that when he expresses opinions that match the thera-
pist's, he gets marginal cues of approval; when he doesn't, he is subjected to
masked hostile analysis. He documents this position with examples. The
therapist, decently and honestly, [confirms this blind spot]. (p. 86)

While the patient's sensitivity to the subtly authoritarian quality in this

relationship stemmed from his own personality dispositions, these
characterological problems were played out in the context of actual con-
tributions from the therapist.

The "Contextual Unit"

In this regard the particular focus on transference taken by the
psychoanalyst Evelyne Schwaber is relevant. In her writing she criti-
cizes the traditional tendency of therapists to respond to transference
material as if it came only from the patient's dynamics. Such a stance
allows the therapist to overlook his/her contribution to the interpersonal
field in which the therapy takes place. She proposes instead that the
participants in therapy are best seen as making up a "contextual unit" in
which each one's experience of the reality in that system comes from
how each one views (that is, makes mental constructs of) the participa-
tion of the other, as well as from what each brings to it in terms of
personality dispositions. From this view Schwaber (1983) notes that her
therapeutic stance is a mode of listening that "is characterized by my
sustained effort to seek out my place in the patient's experience, as part
of the context that is perceived or felt" (p. 523). This means that the
therapist cannot consider herself/himself to be outside the contextual
unit that is the therapy situation, because his/her inevitable participa-
tion determines the very nature of it.
This adds a particular emphasis to the earlier discussion of how
Self-Disclosure and the Nonwhite Ethnic Minority Patient 131

minority patients in particular see it as a matter of self-preservation to

assess their therapist's cultural attitudes and flexibility (Gibbs, 1985;
Jenkins, 1985). Thus, a particular challenge for the therapist with the
minority client is to become aware of-that is, to disclose to oneself-
and master those negative attitudes that are very likely to carryover
from the larger social milieu. Various writers have suggested ways that
therapists can monitor themselves and continue their education (for
example, Acosta, Yamamoto, & Evans, 1982; Cheek, 1976; Russell, 1988;
Smith, Burlew, Mosley, & Whitney, 1978).

Conclusion
I have proposed here that enhancing self-disclosure in therapy with
the nonwhite ethnic minority client requires first that the therapist be
fully conscious of the ongoing racial context in which (s)he and the
patient live. It requires the therapist's recognition that (s)he is in some
way affected by this atmosphere and brings that to the treatment
situation.
I have also proposed that we must add to the usual, too-simple view
of the minority patient as only a victim, facing the double jeopardy of
social oppression and personal psychopathology. The nonwhite ethnic
minority client, like all people, is an agent seeking to further a sense of
competence in life. Minority patients in the interests of survival bring
the same carefully evaluative attitudes to therapy that they have used
historically to adapt to institutions in this society. The effective thera-
pist must be open from the beginning to the special scrutiny of hislher
egalitarianism. (S)he must also be prepared to develop a special sensi-
tivity to the dynamics of language use in the therapy situation. I believe
that there is no question that dynamic psychotherapy relevant to the
patient's personal needs and ethnocultural heritage can be empowering
for minority clients. As Lerner (1974) notes:
Generic psychotherapy is fully compatible with social change because it is an
attempt to restore personal power-self-understanding, self-control, self-
direction, and self-esteem - through the development of an honest, empathic
egalitarian relationship with another human being. (p. 53)
I believe also that such a process can occur in cross-ethnic therapy
situations if a skilled therapist is honest and open with himself/herself
and prepared to learn.

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 10
Feminist Therapy Perspectives
on Self-Disclosure
Laura S. Brown and Lenore E. A. Walker

Introduction
Unlike many other theories of psychotherapy, feminist therapy theory
has from its inception promulgated the idea that self-disclosure by the
therapist, may be a valuable part of the therapy process (Greenspan,
1986). This concept appears in some of the earliest literature addressing
the nature of the client-therapist relationship in feminist therapy (Man-
der & Rush, 1974; Lerman, 1976; Rawlings & Carter, 1977), and has
continued to form a core of the feminist therapy mandate to empower
clients, as well as heal their wounds. Guidelines for the use of self-
disclosure can be found in the Ethical Code of the Feminist Therapy
Institute (FTI), which specifically refers to ethical ways in which self-
disclosure can and should be used by a therapist (Feminist Therapy
Ethical Code, 1987), and discussion of the implementation of this code
and its norms is ongoing (Lerman & Porter, 1990). This proactive em-
brace of self-disclosure is unique among theories of psychotherapy, and
reflects certain core tenets of feminist therapy theory regarding the
relationship of client and therapist and the role of the therapist in the
healing process.
In this chapter, we will review those aspects of feminist therapy
theory that tend to support the use of self-disclosure in therapy, discuss
the development of that theory, including some of the early difficulties

Laura S. Brown • 4527 First Avenue NE, Seattle, Washington 98105. Lenore E. A.
Walker. Walker and Associates, 50 South Steele Street, Suite 850, Denver, Colorado 80209.

135
136 Laura S. Brown and Lenore E. A. Walker

encountered in the use of self-disclosure, and then explore ways in

which feminist therapists use self-disclosure as a part of their work. In
reviewing this history, it is important to remember that feminist therapy
is a grassroots phenomenon with no single acknowledged founder or
leader. It grew out of critiques by the feminist movement of the 1960s and
early 1970s in the United States, which pointed out that the goals of
traditional psychotherapy appeared to promote women's adjustment to
an oppressive status quo rather than supporting women's struggles to-
ward equality (Chesler, 1972; Weisstein, 1970).
Initially, feminist therapy was primarily a philosophy by which
therapy was approached rather than a prescription of techniques, al-
though certain norms were implied. The acceptance and, some would
say, the implied prescription of self-disclosure so as to create a "con-
sciousness-raising group of two" (Maracek & Kravetz, 1977) was one of
the hallmarks of this "first generation" philosophy of feminist therapy.
By the early 1980s, feminist therapy began to integrate into its core those
modifications to traditional systems that had been made by feminist
practitioners of various standard approaches to psychotherapy. This
"second generation" of feminist therapy theory created variations on the
model for self-disclosure and debates about its use, but retained the
notion that therapist self-disclosure and the active use of self by the
therapist were essential elements of feminist therapy practice (Douglas
& Walker, 1988; Ballou & Gabalac, 1985; Sturdivant, 1980). Work is cur-
rently in progress on the development of a cohesive model of feminist
therapy, and all indications are that self-disclosure will continue to hold
a central place in what might be called the "third generation" of feminist
therapy (Dutton-Douglas & Walker, 1989; Lerman & Porter, 1990).

A Brief Review of Self-Disclosure

in Feminist Therapy Theory
Feminist therapy as a concept arose from the second wave of the
North American women's movement in the late 1960s and early 1970s. It
was spread by word of mouth throughout Europe and South America,
and its worldwide practice was well established by the time of the 1985
Nairobi Conference marking the end of the UN Decade for Women
(Gore & Walker, 1986). Feminist therapy as practiced reflects the norms
and modes of mental health care delivery that predominate in a given
cultural or social context. However, certain tenets appear to be core and
to transcend cultural differences.
During the initial development of feminist therapy theorizing, psy-
chotherapists who were also feminists began to apply the political cri-
Feminist Therapy Perspectives 137

tique of sexism found in other cultural institutions to the institution of

psychotherapy. Data had begun to grow demonstrating the negative
impact of sexism and sexist practices on women's mental health (Walker,
1984a; Reiker & Carmen, 1984; Chesler, 1972). In addition, feminists in
general targeted psychotherapy as one of those institutions of modern
culture that attempted to impose social controls on women's freedom of
action and self-definition by defining a rigid feminine gender role as the
only path for "normalcy" or "mental health" for women.
Such critiques resonated for many women, and in fact found empir-
ical validation soon after being raised in the work of Broverman and her
colleagues, which demonstrated the presence of a double and lesser
standard of mental health for women (Broverman, Broverman, Clark-
son, Rosencrantz, & Vogel, 1970). Other critiques exposed how labeling
women as psychologically "ill" was used as a strategy for maintaining
women in their prescribed social roles (Chesler, 1972), and sexist bias
within the practice of psychotherapy was described (Report of the Task
Force, 1975). Although almost two decades have passed since these criti-
cisms were first raised, current data suggests that gender bias still re-
mains a problematic and present factor in the practice of traditional
psychotherapies (Rosencrantz, Delorey, & Broverman, 1985; Rosewater
& Walker, 1985; Ballou & Gabalac, 1985).
Seizing upon these criticisms, early feminist therapists attempted
to integrate this political analysis into their work with clients. Such
political analysis included the compilation of individual women's stories
with the goal of extracting a common theme that could be used to help
clients comprehend the roots and impact of their oppression. This femi-
nist notion that "the personal is political" grew from the consciousness-
raising process in which women joined together to share personal
stories in a nontherapeutic context of mutual self-help and support.
Because of the blurred boundaries between feminist therapy as it
was first practiced and consciousness-raising, which was an explicitly
political rather than therapeutic approach to women's lives and prob-
lems, some early feminist thinkers felt that therapy of any sort would
undermine political analysis and growth, and could not avoid some of
the problems inherent in the psychotherapy process per se (Wycoff,
1977). This criticism that any therapy, even feminist therapy, is overly
embedded in traditional and masculinist social status quos is still held
by some feminist philosophers (Hoagland, 1988; Dykewomon, 1988;
Raymond, 1986). Others have attempted to reconcile these tensions by
overtly integrating political action into therapeutic work (Pheterson,
1988). However, many other feminists, desiring a psychotherapeutic ex-
perience for themselves, have felt that a feminist therapy perspective, in
which attention was paid to social and contextual factors, was valuable
138 Laura S. Brown and Lenore E. A. Walker

and worth developing. Much of the initial work of feminist therapists

centers on sorting out the differences between problems of living that
are common to the experience of being a particular gender, race, class, or
sexual orientation, as opposed to problems that are still current evi-
dence of individual personal problems.
The first generation of feminist therapists also struggled with the
questions of whether and to what degree biology as versus social context
contributed to the development of personality. The initial resolution of
this question within feminist therapy was to assume social construction
of gendered behavior until and unless more convincing evidence could
be marshaled for a biological explanation. Since the sexist bias of the life
sciences in the formulation and interpretation of research questions has
been well-documented (Bleier, 1984), most feminist therapists would
agree that while there is most likely an interactive relationship between
nature and nurture in the development of gendered behavior, the mean-
ing and contribution of biology cannot be well understood at this time
because of this bias in the biological literature and its impact on the
nature of empiricism and scientific inquiry.
Although feminist therapy does not, as previously mentioned, have
a founder or official spokesperson, most feminist therapists would prob-
ably agree with certain basic definitions of feminist therapy (Green-
span, 1983; Rosewater, 1988; Brown & Liss-Levinson, 1981; Cammaert &
Larsen, 1989; Dutton-Douglas & Walker, 1989; Gilbert, 1980). Such defi-
nitions emphasize that the absence of equality between women and
men in social, political, economic, educational, and other spheres re-
quires that therapists take a stance of political action and advocacy, and
that such a stance be explicitly integrated into the work of therapy. This
proactive advocacy model differentiates feminist therapy from nonsexist
therapy, an approach that simply acknowledges that such inequalities
exist (Rawlings & Carter, 1977). The modal definition of feminist therapy
includes norms for practice. These include the importance of developing
an egalitarian relationship between client and therapist as a model for
the overall development of such relationships in the client's life and the
rendering of close attention to the impact of all the various forms of
oppression and discrimination experienced by clients, including but not
limited to rabsm, classism, heterosexism, homophobia, ageism, able-
bodiedism, and fat oppression. Another important modal value of femi-
nist therapy has been that of analysis of the power imbalance inherent in
the psychotherapeutic relationship, and a focus on empowering clients
to define the meanings of their own lives. Feminist therapists have paid
particular attention to the impact of high base-rate phenomena in wom-
en's lives, such as violence in the home, and have noted how the common
female experience of being harmed and betrayed by one on whom you
Feminist Therapy Perspectives 139

are dependent and whom you love (e.g., incestuous fathers, battering
partners) implies careful attention to the arrangement of power and
dependency in the psychotherapeutic relationship. Feminist therapists
have attempted to develop strategies for reducing rather than reinforcing
the power imbalance. Therapist self-disclosure has been such a strategy
in a relationship of inherently unequal power such as psychotherapy.
The corrective experience, as conceptualized from a feminist thera-
py framework, has included the therapist's ability to aid her client in
expanding herlhis vision of the alternatives available so that she/he can
make informed choices rather than nonconsciously acquiescing to the
norms of sexist stereotypes (Bern & Bern, 1976). Change is construed as
occurring in all domains, e.g., cognitive, affective, and behavioral, and
a variety of techniques have been integrated into feminist therapy prac-
tice to provide the opportunity for such changes. Bibliotherapy, body
work, dream analysis, political analysis, skill enhancement, cognitive
restructuring and reframing, desensitization, assertion training, gestalt
awareness techniques, and various approaches to affective catharsis
have all found a place in the work of feminist therapists (Dutton-
Douglas & Walker, 1989; Rosewater & Walker, 1985).
In picking and choosing different techniques from among already
extant therapies, first generation feminist therapy developed as a hy-
brid. However, each of these approaches, often developing initially in
ignorance of others, has maintained the convergence on those modal
principles of feminist therapy described, and resemble one another
closely enough to be all included under the rubric of feminist therapy.
While some groups of feminist therapists have concentrated on main-
streaming its perspective into traditional approaches to psychotherapy,
(cf. the work ofthe Stone Center group of authors) others have aimed at
creating a system separate and unique from the mainstream (Brown,
1988a). Second and third generation feminist therapy includes both
these perspectives (Dutton-Douglas & Walker, 1988).

Self-Disclosure in Feminist Therapy Theory

Among one of the primary critiques leveled by feminists against
psychotherapy, as it has been traditionally practiced, is the nature of the
power imbalance between therapist and client. Therapists, who have
traditionally mostly been men, treat clients, who have been predomi-
nantly women, from behind the cloak of anonymity and authoritarian
expertise. This heritage from the psychoanalytic roots of therapy prac-
tice encourages therapists to retain power and take control of the thera-
py session. The male therapist, with his role-assigned expertise, often
140 Laura S. Brown and Lenore E. A. Walker

feels free to make pronouncements and prescriptions to his female cli-

ents about how best to lead their lives. Although therapists are profes-
sionally socialized to see themselves as anonymous and value-free,
making only such behavioral prescriptions or interpretations as are
clearly in the client's best interests, the data from research on sexism in
psychotherapy shows that therapists in actuality promote a very partic-
ular value system, one that reflects an androcentric norm (Chesler, 1972;
Report of the Task Force, 1975; Rawlings & Carter, 1975). One of the
earliest goals of feminist therapy has been to attempt the rebalancing of
power in psychotherapy. This is accomplished by attending to those
elements of the therapy process that enhance the power differential,
then moving to modify or eliminate them. Self-disclosure, which makes
the therapist's values known and available for scrutiny and discussion
by the client, is but one of several methods initially used to accomplish
this rebalancing (Greenspan, 1986).
Given the core principle of feminist therapy that the therapy rela-
tionship should be an egalitarian one, in which the values of the thera-
pist are clearly delineated so that the client is freer to reject or accept
them in a conscious fashion, several strategies became popular in first
generation feminist therapy practice. First names have been used by
both therapist and client, rather than having the therapist called by the
honorific "Dr. X," while the client is referred to by her first name. This
change acknowledges the equal value of each partner in the therapy
process, and particularly is meant to underscore the importance of the
client's contribution to therapy rather than minimizing the value of the
therapist's contribution. The client has been defined as fully expert re-
garding her own needs and values as the therapist, with the therapist's
expertise more narrowly defined in terms of specific knowledge and
skills that are useful in facilitating the client's goals. Although on occa-
sion either therapist or client carried this equalizing process to extremes
in which the therapist's knowledge was so devalued as to undermine
any therapeutic movement at all, in general this move away from an
authoritarian model for therapists models a challenge to therapist power
and was taken up by other systems of psychotherapy during the 1970s.
Formal diagnosis was initially eschewed as unnecessarily stig-
matizing and as serving only to create distance between therapist and
client (Rawlings & Carter, 1977). The process of diagnosis and assess-
ment as traditionally practiced encouraged therapists to think and talk
about their clients in a particularistic language, not readily understood
by the client; the metamessage of such diagnostic thinking was to create
a separate species of humans, called by their various diagnostic catego-
ries, from whom therapists maintained emotional and social distance.
The methods by which formal psychiatric diagnoses were developed
Feminist Therapy Perspectives 141

were also problematic in being themselves biased by sexist and other

oppressive perspectives (Kaplan, 1983; Caplan, 1984; Rothblum, Solo-
mon, & Albee, 1986). While feminist therapists have begun to reevaluate
the use of diagnosis in their practice, particularly in light of recent
movements towards even more sexist diagnostic categories in the latest
revision of the Diagnostic and Statistical Manual III (1987), this reevalua-
tion has focused on ways in which diagnosis becomes a dialogue between
client and therapist with the client empowered to better understand the
social and cultural roots of her/his distress (Brown, 1986, 1988b; Walker,
1986, 1988). Feminist therapists would argue that in order to participate
in this egalitarian approach to diagnosis, a certain degree of therapist
self-disclosure is required, both to clarify how the therapist developed
her/his perspectives, and to model more openness by the client in shar-
ing information for the diagnostic process. Thus, the therapist must
disclose how she/he has developed her/his hypotheses about the client,
what theories she/he references, and how she/he has included or dis-
carded particular diagnostic ideas, rather than appealing to authority in
imposing a diagnosis.

The Nature of Self-Disclosure in Feminist Therapy

Feminist therapists are encouraged to disclose to their client their

personal values and biases, usually verbally, (although some feminist
therapists also utilize written information to aid in the retention of such
data) as part of the development of the therapeutic relationship (Mander
& Rush, 1974; Wycoff, 1977; Greenspan, 1983; Brown & Liss-Levinson,
1981). To facilitate this process, feminist therapists have developed
guidelines for clients about how to elicit such information and strategies
for challenging therapists who are unwilling to be forthcoming. Such
feminist psychology organizations as the Division of Psychology of
Women of the American Psychological Association (APA), APXs Com-
mittee on Women in Psychology (CWP), and the Association for Women
in Psychology (AWP) have participated in jointly preparing, publishing
and distributing consumer rights pamphlets aimed at women psycho-
therapy clients (Women and Psychotherapy, 1985; If Sex Enters, 1987).
Consumer rights have thus been one factor motivating the use of at
least some degree of self-disclosure as a norm in feminist therapy. If the
therapist did not disclose information such as her/his views on highly
charged and value-laden topics, e.g., nonmonogamous relationships,
reproductive rights, women working outside the home, or lesbianism,
then how was the client to know whether the therapist would offer (as
would be hoped) nonsexist and unbiased support should these issues
142 Laura S. Brown and Lenore E. A. Walker

arise? Clients were also encouraged by feminist therapy consumer

guidelines to find therapists who matched them on such variables as
ethnicity, class background, sexual orientation, or political values, not
all of which are apparent simply from visual inspection of the therapist.
For clients to obtain such information with which to make decisions
about seeing a particular practitioner, therapists were required to dis-
close a large amount of what had previously been considered personal
and off-limits data about themselves.
A second goal for self-disclosure in feminist therapy was to facili-
tate the therapist's serving as a role model for her clients (a supposition
which underlies the suggestion that clients find therapists who matched
them demographically). In our own participation in the consciousness-
raising group process of the late 1960s and early 1970s, feminist thera-
pists had discovered that many of what had seemed private and unique
concerns were in fact issues that most other women had faced and dealt
with. Many feminist self-help groups were an outgrowth of this realiza-
tion. The sharing of experiences between women feels so liberating, as
well as healing, that the spirit of consciousness-raising groups pervaded
early feminist therapy theorizing. As described earlier, individual femi-
nist therapy has been construed as potentially being a consciousness-
raising group of two (Kravetz, 1976). When the therapist self-disclosed
and shared her personal vulnerabilities and solutions with the client,
she validated the client's realities, letting the latter know that shelhe was
not alone nor pathological in herlhis dilemmas. The therapist would
become more real, more human. Symbolic or transferential aspects of
the therapy process were downplayed or devalued in this first-generation
approach to self-disclosure (Brown, 1984a; Greenspan, 1986). However,
problems soon began to arise with this strategy, which will be more
fully discussed at a later point.
One outgrowth of this devaluation of the transferential aspects of
the therapist-client relationship was a series of experiments by feminist
therapists in modifying the meaning of dual relationships so as to en-
compass ethically what appeared to be often unavoidable overlap be-
tween the personal and social lives of feminist clients and feminist
therapists (Berman, 1985). Feminist therapists recognized that feminist
communities functioned as psychological small towns; the probability
became high that clients and therapists would encounter one another at
political gatherings, women's cultural events, and even in social settings
in the homes of mutual acquaintances (Brown, 1987a, 1990). Feminist
therapists' personal behaviors and political beliefs may thus be dis-
closed to clients by demonstration or reputation within a community
(Brown, 1984b). It quickly became apparent to many feminist therapists
that it was impossible to create any semblance of anonymity in their
Feminist Therapy Perspectives 143

work, and that the real self of the therapist would always be integrated
into any symbolic representations that the client might develop.
If a particular feminist therapist is well-known and her opinions
represented by the media when she is called upon as an expert in her
field, she also self-discloses; at times, this can lead to distortions of the
therapist's actual beliefs that must then be clarified with clients. Addi-
tionally, such self-disclosure means that the therapist may be known,
occasionally inaccurately, to potential clients; without the therapist's
making overt self-disclosures, clients enter treatment with knowledge of
who the therapist is (both authors of this chapter, for example, have had
new clients inform us that we were chosen after reading one of our
published works). Often, particular issues provoke controversy within
feminist communities (e.g., pornography, surrogate motherhood).
When a feminist therapist is known to espouse one among many di-
verse positions on such an issue as the result of her own active participa-
tion in the feminist political discourse, she also self-discloses, whether
she chooses to do so actively in a therapy session or not. Such political
activity is considered ethically imperative for feminist therapists (Femi-
nist Therapy Ethical Code, 1987); consequently, no matter how low the
level of exposure that a particular feminist therapist might choose to
express her political activism, it will lead to some degree of self-
disclosure by implication.
Finally, the use of self-disclosure in feminist therapy was fueled by
reaction against the overly distant, pseudo-anonymous style of ortho-
dox psychoanalysis, which was the highest-status and often primary
therapy modality being practiced during the period in which feminist
therapy began to develop. Feminist therapists have continued over time
to be critical of an overly distant style on the part of androcentrically
trained therapists (Jordan, Surrey, & Kaplan, 1983; Greenspan, 1986).
In fact, some recent authors (Lerman & Porter, 1990) have suggested
that being overly distant may be as damaging and thus ethically prob-
lematic in therapy as is an overt violation of a boundary under the guise
of "closeness." Many early feminist therapy writings contain first-
person accounts of frustration and struggles against the wall of a silent
male analyst (Chesler, 1972; Report of the Task Force, 1975; Mander &
Rush, 1974; Greenspan, 1983). Since criticism of other aspects of psycho-
analytic theory and practice is also a common aspect of first generation
feminist therapy writings, it should not be surprising to find that one
remedy suggested for transforming therapy to a more human exchange
was the encouragement of personal openness and genuineness on the
part of the therapist. In this regard, early feminist therapy thinking was
also strongly influenced by the work of Rogers (1951, 1961) and Perls
(1971) regarding the value of the use of self by the therapist. The
144 Laura S. Brown and Lenore E. A. Walker

humanistic psychology movement of the 1970s had a profound impact

on the training of many current feminist therapists, and a relationship
between feminist therapy and other theories emphasizing personal
growth and valuing wholeness is still quite common.
Several early feminist therapy writers also promulgated a perspec-
tive on therapy in which the therapist was more of a "facilitator," and
less a therapist. This can particularly be found in the work of Wycoff
(1976, 1977) and other writers who worked within the context of the
Berkeley Radical Psychiatry movement of the early 1970s (Steiner, Wy-
coff, Goldstine, Lariviere, Schwebel, & Marcus, 1975). This school of
thought, which began as an offshoot of Transactional Analysis, under-
played the special role of the therapist, and discouraged individual psy-
chotherapy in favor of "problem-solving groups," in which all, including
the facilitator, would work together as co-equals to deal with whatever
issues group members would bring up. In such a context, which can still
be found in the form of women's self-help groups, self-disclosure by the
therapist/facilitator was a given, since she was expected to be a partici-
pant in the group herself, and to share in the process of personal and
political analysis that took place.
All of these factors combined to create an implicit norm among
feminist therapists that it was therapeutic to share our own experiences
with our clients when the latter came to similar developmental mile-
stones or crises. While most feminist therapists were able to integrate
this use of self-disclosure into their work in a way that continued to be
respectful of the needs and boundaries of the client, some problems
arose early on that pDint out how self-disclosure, while continuing to be
useful, must be applied in a very specific and thoughtful way rather
than generally and across the board.

Problems in the Use of Self-Disclosure

in Feminist Therapy
Perhaps the most common problem that arose among feminist
therapists who were using self-disclosure as a therapeutic technique
was the way in which it risked a blurring and obscuring of boundaries
between the roles of client and therapist. Some therapists found them-
selves, under the guise of using self-disclosure to help the client, taking
the therapy hour to discuss and deal with their own personal problems,
thus engaging in what feminist therapists would consider unethical and
potentially damaging role reversals. Such therapists were often substi-
tuting their own needs for supervision, consultation, or personal thera-
py with "mutual consciousness-raising" with clients. Some more naive
Feminist Therapy Perspectives 145

therapists equated the concept of "egalitarian" relationships in therapy

with "equal" relationships, attempting to establish a symmetry that was
not present and could not be therapeutic, creating confusions between
friendship and psychotherapy (Hoagland, 1988). "Empowering the cli-
ent" by making her into the therapist's confidant was one particularly
potentially harmful misapplication of the feminist therapy principles
regarding self-disclosure.
Because self-disclosure was allowed and, to a certain degree, en-
couraged among therapists who often had no training or role models for
effecting this behavior appropriately, it became difficult for some femi-
nist therapists to allow themselves their own personal boundaries and
privacy, and not to self-disclose at the client's request when it felt uncom-
fortable, unwise, or countertherapeutic to do so. This was often the case
when the clients themselves were members of the feminist political com-
munity, and consequently invested in the belief that the therapist's
views on all issues should be known so that that client could feel com-
pletely mirrored and validated.
Additionally, the small-community aspect of feminist therapy work
often meant that the therapist's own joys and griefs would be known to
clients; when a particular therapist prefers that she process her own
pains in the privacy of friendship networks, therapy, or consultation,
such a desire for boundaries should not be seen as running counter to
the feminist therapy norm of self-disclosure, particularly since a client's
request for more information may in fact be a thinly disguised wish for
reassurance that the therapist will still be present for the client while
processing her own issues. Each of the current authors has had the
experience of having personally painful events occur in ways that made
them known to parts of our client network, and has found that often
what is most essential to actively self-disclose to clients at such times
(given that the noncontrolled self-disclosure that we described has al-
ready occurred without our intent to share) is our ongoing commitment
to self-care, which will not include processing the problem with our
clients nor leaning on them for support in our own times of need. This
modeling of self-care and the choice of appropriate sources of emotional
support, can, however, be a useful application of self-disclosure, partic-
ularly with women clients who are themselves in caretaker roles.
It is not unusual for meetings of feminist therapists to be filled with
conversations about difficult decisions in boundary management, espe-
cially with clients who are part of the feminist political community.
Therapists discuss feeling trapped when queried by clients who are
political activists, in particular when the latter represent viewpoints
different from our own. This can be especially challenging when clients
present with strong tendencies towards splitting and severe narcissistic
146 Laura S. Brown and Lenore E. A. Walker

wounds that demand constant mirroring and validation. Feminist thera-

pists can often feel caught between the perceived "imperative" to self-
disclose upon request, and our own needs to maintain privacy and
exercise clinical judgment. Learning to create this balance has charac-
terized much of the work done in the second and third generations of
feminist therapy theory development (Brown, 1987a).
Another problem that arose early in the development of feminist
therapy with the use of self-disclosure was that it encouraged therapists
to overgeneralize from their own experiences, and potentially discount
and devalue differences between the needs, skills, and resources of
client and therapist. This problem takes on particular significance when
client and therapist differ on such important variables as race, class,
sexual orientation, age, and other factors that tend to affect a person's
degree of personal safety and cultural privilege. As was pointed out in
an earlier paper by one of the authors (Brown, 1988a), using the personal
as a heuristic for generating strategies to share with your clients may be
fine as long as you are generalizing to other members of your own group.
Even with a perfect match on all overt variables, however, there will be
ways to deal with a problem other than those used by the therapist.
After all, another central tenet of feminist therapy has been to empower
clients to explore all possible alternatives so as to make an informed
choice. Thus the therapist must support the client in finding her/his own
way, at herlhis own pace, without undue pressure to follow the thera-
pist's path via intrusive self-disclosures. The gratuitous assumptions of
early feminism that all women's experiences would be similar ignored
the very real differences among women (Kanuha, 1990).
Self-disclosing the strategies used by an upper middle-class, highly
educated heterosexual white woman to a client who has only female
gender in common with the therapist ignores both the very real differ-
ences in.access to resources available to the therapist, as well as obscu-
ring the unique and rich possibilities for productive coping that might
be culture, class, or social-group specific. Even when the therapist her-
self was a member of one minority group, her strategies might not be
appropriate or useful for members of a different minority group
(Greene, 1986). Self-disclosure, then, could offer an overly simplistic
way of creating a false sense of empathy and connection between cultur-
ally different clients and therapists. This glossing over of differences
during the first generation of feminist therapy had the effect of alienat-
ing some working-class, ethnic, and sexual minority clients (Cardea,
1985; Kanuha, 1990).
A final problem with the use of self-disclosure in feminist therapy
has to do with the motivations for its use. In theory, self-disclosure
occurs to empower the client. It demystifies the person of the therapist
Feminist Therapy Perspectives 147

and makes her more human, reducing the "us vs. them" quality of the
interaction, and underscores the impact of the therapist's personhood
on the interaction rather than her formal training. Although the poten-
tial danger here is that the therapist's personality becomes more impor-
tant than her skills, thus increasing the risk of a cult developing around
a particular therapist (Brown, 1990b), in the best of all worlds it allows
the client to experience therapy as an interchange between two humans
rather than between "expert" and "patient." Self-disclosure can decrease
the isolation of the client, allowing her to see how her problems have
been encountered even by her therapist. In theory, self-disclosure is one
response that a feminist therapist can make to the client's needs for
sisterhood and solidarity.
In practice, however, self-disclosure can become distorted into a
strategy for the therapist to reduce her own isolation. Hill (1990) has
pointed out that therapists (feminist as well as otherwise) often engage
in low-level violations of their clients' boundaries by self-disclosing at
inappropriate times in order to meet their own needs for emotional
intimacy, contact, nurturance, and validation. Those feminist therapists
who themselves feel marginal (Coffman, 1988) may have an even more
difficult challenge in selecting appropriate times for self-disclosure with
the client's needs as sole or primary.
As Hill points out, feminist therapists may be particularly vulner-
able in this regard because of our commitment to appear as genuine
human beings rather than as mystified therapy goddesses. If we are
steadfast in our commitment, we may lose some of the usual intangible
rewards of the work of therapy, e.g., feeling oneself glowingly respons-
ible for the client's progress or savoring the role of expert and guide. On
occasion, the tension generated by balancing genuineness with respect
for the client's boundaries and a focus on the client's wants and needs
may be the catalyst for inappropriate self-disclosures, statements that
serve primarily to soothe the therapist rather than enlighten or em-
power the client. One client, speaking of another feminist therapist with
whom she had chosen to terminate treatment reported that she had
decided to stop because she was tired of hearing about how the therapist
had dealt with their many shared issues. "I wanted the time and space
to talk about my experiences, and didn't want to hear about what she
had done. After a while it stopped being helpful and started feeling
selfish."
In this and other similar cases the therapist may be substituting
self-disclosure and the use of personal experience for reliance on appro-
priate training and consultation, access to information, or therapy exper-
tise. It is thus noteworthy that the Feminist Therapy Ethics Code
requires attention to consultation, supervision, ongoing training, and
148 Laura S. Brown and Lenore E. A. Walker

self-care as ethical imperatives, along with the appropriate use of self-

disclosure. As feminist therapy has developed, we have found that pre-
venting distress in the therapist appears to be one of the most efficacious
strategies for continuing to work in an empowering rather than authori-
tarian manner.
Many of these problems with the use of self-disclosure occurred in
the early period of feminist therapy, before we had developed clear
models for its use, and at times when training and experience were
undervalued. The problems that we have discussed tend currently to
arise when a given feminist therapist is either inexperienced, poorly
trained, or lacking in appropriate resources for self-care. It is not the
permission to self-disclose, but rather inadequate preparation on the
part of the therapist to use self-disclosure that accounts for such prob-
lems. In fact, when self-disclosure is both professionally ego-syntonic,
and modeled appropriately in training, consultation, and supervision, it
is more likely to be used in an effective and clearly therapeutic manner
than when it is perceived by the therapist as an error or a rebellion
against training.

Current Applications of Self-Disclosure

in Feminist Therapy
One of the most enduring aspects of self-disclosure in feminist
therapy has been the consumer education model used by most feminist
therapists in initiating work with new clients. Such self-disclosure typi-
cally includes, although is not limited to, information about the thera-
pist's values and therapeutic orientation, and the outline and rationale of
the course of treatment to be pursued. Mutual goal-setting as well as
open discussion about therapeutic techniques that the therapist can be
expected to use are also often included in initial sessions. Feminist
therapists are more likely to discuss the question of diagnosis with the
client and work cooperatively to choose the appropriate category, rather
than simply imposing a diagnostic label. Feminist therapists are also
likely to educate the client about how the diagnosis will be used. A
number of feminist therapists routinely share written information with
clients about their rights as consumers of psychotherapy, and may have
written or oral contracts with the client, presaging recent developments
in some states which now require that all therapists share such informa-
tion. It is not unusual for feminist therapists to frame an initial session
as a mutual decision-making interview, often conducted at a reduced
fee. During this initial session, the client is actively encouraged to ask
both personal and professional questions about the therapist in order to
Feminist Therapy Perspectives 149

make as informed as possible a decision about working with this partic-

ular therapist. This session also offers the therapist the opportunity to
clarify what her limits are regarding the sharing of information (e.g., "I
will gladly share my views on a particular topic, e.g., non-monogamy,
but I will not be willing to share details of how I integrate them into my
personal life"), modeling the ability of both parties to have their bound-
aries respected while maintaining an atmosphere of openness and
flexibility.
It has been the experience of feminist therapists that this consumer-
rights orientation to the use of self-disclosure in the therapist selection
process makes a powerful initial statement to clients about the nature of
the psychotherapy relationship. Therapy is framed as being simul-
taneously healing/protective and empowering. Clients comment that
they feel safer and more trusting of a therapist who is willing to be
forthcoming, and who, in essence, models that sharing some type of
personal information is a risk worth taking. There is also an immediate
sense of boundaries being valued, and thus an awareness that the cli-
ent's needs to control the pacing of the process will be respected. Clients
often comment that even though they may have had no questions to ask
of their therapist at an initial encounter, they felt less frightened about
starting therapy because they knew that the permission to ask was
present.
The original feminist therapy notion that self-disclosure by the
therapist would create an atmosphere of shared value and expertise has,
with some modifications, proved to be of use as well. Feminist thera-
pists have become more sensitive to the wide varieties of female experi-
ence and to the ways in which we differ from our women clients; this has
allowed us to fine-tune our use of self-disclosure. But the overt permis-
sion for the therapist to self-disclose or for the client to request informa-
tion has been useful for coping with unusual occurrences in the lives of
either therapist or client, or with those situations in which the thera-
pist's style or practice setting calls for more personal information to be
shared.
For example, one author (Walker) is frequently involved in media
interviews, and often travels away from her therapy practice to testify in
forensic settings, usually in highly publicized cases of battered women
who kill in self-defense. Her clients may need to know literally where
she is on a given day, and to have sufficient information about her public
work to feel comfortable sharing her in this way. Some clients need the
reassurance that their problems are not seen by her as trivial when
contrasted with the dramatic issues they see her dealing with in the
media and out of town. The other author (Brown) has developed a neu-
rological impairment that leaves her unable to talk without mechanical
150 Laura S. Brown and Lenore E. A. Walker

assistance for several months during each year. During the period of
time in which her condition was quite audibly developing and being
diagnosed, her clients felt free to ask the questions they needed in order
to feel secure in their therapist's availability, and certain that the thera-
pist was pursuing appropriate medical intervention. Yet they knew that
the therapist would not intrude that information into the relationship,
but rather would make it available upon request.
While these examples may seem highly unusual, in fact it is our
experience that most therapists are likely to have events occur in their
nontherapy lives that visibly leak into their practice. Rather than pro-
moting a game of hide-and-seek between client and therapist, the femi-
nist therapy model gives clear guidelines about the appropriateness of
self-disclosure, as well as giving the therapist the message that she/he
will need to plan in advance with how to disclose when such inevitable
events as birth, death, illness, or personal transformation of some kind
occur.
Since many of the clients who seek feminist therapy are victims/
survivors of violent or otherwise dysfunctional families in which prob-
lems were never discussed in an open manner, and in which secrets
were kept, even though people could sense that something serious was
wrong, the therapists' willingness and comfort in providing information
about their own situations serves as an opportunity to process old pain
about secrets and the denial of one's perceptions. The timing of dealing
with issues such as these in the life of the therapist needs to be carefully
evaluated with regard to each client. The therapist does not disclose ad
libitum, but rather to those clients who inquire or who appear to need to
know, and only the information that is appropriate for the particular
client-therapist dyad at that point in time. In some cases when the client
has a history of needing explicit support to ask for clarification, having
already discussed with the therapist at the inception of treatment that
asking is acceptable and will be responded to in a genuine and positive
manner can be an essential element in the client's ability to ask, and the
therapist may refresh this permission by clarifying that this may be one
of the times when the client has questions they wish to raise.
Such a reliance on the client's initiation of the request for more
information rather than simply providing it to her is one of the major
transitions in the use of self-disclosure that we have seen occur over the
two decades of feminist therapy practice, a change that brings the prac-
tice even closer to the norm of empowering the client. Now, rather than
the therapist deciding what part of her experiences the client should
hear, the client is given encouragement and permission to ask for infor-
mation as she/he perceives the need for it, but also the same support to
not receive it. This makes the act of self-disclosure less likely to be an
Feminist Therapy Perspectives 151

engagement in narcissistic self-indulgence on the part of the therapist,

and further empowers clients by giving them a chance to practice skills
to ask for what is needed. Feminist therapy thus also has become more
clearly differentiated from consciousness-raising per se; while each re-
mains a political act and integrates political analysis, feminist therapy
has more concretely claimed the territory of healing, with political advo-
cacy work seen as less immediately and directly central to the work of
feminist therapists in the therapy hour. Feminist therapists continue to
share information and resources with clients, but in a manner that is
more respectful of what the client wishes to know. The asymmetry of the
relationship and the distinction between egalitarian and genuinely
equal is explicitly acknowledged, while the commitment to openness is
retained.

Conclusion
Women have, in the past two decades, reclaimed and recreated their
ancient role and work as healers through the development of feminist
therapy. Being a feminist therapist requires special training in feminist
techniques and philosophy and a grounding in the new feminist schol-
arship on the psychology of women. It also leads to a connection to a
larger spiritual movement which emphasizes the interrelatedness be-
tween women's mental and physical health. Our growing awareness of
the extent to which women, people of color, other oppressed groups,
and the very planet itself have been violated by patriarchal power and
attempts to impose control makes this feminist political perspective
crucial if we are to develop the long-term strength and strategies to heal
these wounds and return power to those who have been violated
(Spretnak, 1982; Greenspan, 1988). Our belief, consonant with that of
most feminist therapists, is that the basic tenets of feminist therapy are,
at their core, those which are necessary for good therapy, in which there
is both closeness and empathy, yet respect for boundaries and human
diversity. The use of self-disclosure has been a primary technique uti-
lized by feminist therapists in building a feminist, egalitarian, and gen-
uinely healing approach to psychotherapy.

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 IV
Therapeutic Modalities
 n
Self-Disclosure and Psychotherapy
with Children and Adolescents
Nicholas Papouchis

Introduction
The focus of this chapter is a discussion of the concept of self-disclosure
as it applies to therapeutic work with adolescents and children. This
begins with a brief discussion of the relevance of self-disclosure in psy-
chotherapeutic work with adults, in order to demonstrate the impor-
tance of using a developmental perspective in understanding this
phenomenon in work with a younger population. It will also briefly
review the positions taken by different analytic schools of thought re-
garding the therapist's self-disclosure in work with adult patients.
In the discussion that follows, the terms analyst and psychothera-
pist will be used interchangeably, although the author acknowledges
that there are technical differences between the two.

The Concept of Self-Disclosure

In our interactions with other people we reveal ourselves in many
ways. The tone of our voice, the way in which we position our body, our
ability to make eye contact, the distance we maintain when talking
to one another all reveal something about us. Many of these behaviors
are automatic and outside of conscious awareness. By contrast, in the

Nicholas Papouchis • Program in Clinical Psychology, Long Island University, Brooklyn

Center, Brooklyn, New York 11201.

157
158 Nicholas Papouchis

traditional psychotherapeutic situation with adults, verbal communica-

tion between the participants is the major form of interaction. Therapist
and patient reveal themselves primarily through the verbal interactions
that take place in the therapeutic setting. Seen in this context, self-
disclosure has been equated with verbal disclosure. This definition has
also been restricted to verbal information intentionally revealed by one
person to the other.
The concept of self-disclosure and its impact on the therapeutic
process has been discussed most thoroughly in the work of Jourard
(1964, 1968, 1971), who argued in favor of the reciprocal nature of self-
disclosure. He maintained that self-disclosure on the part of one partici-
pant in an interaction had a dyadic effect, in that increased openness
on the part of one individual led to increased openness on the part of
the other. When applied to psychotherapy, advocates of the existential
position espoused by Jourard (1971) have argued that the therapist's self-
disclosures serve a critical function in building the therapeutic relation-
ship. The patient's increased ability to be genuine and self-disclosing
was thus seen to be a direct result of the therapist's behavior. Similarly,
Truax and Carkhuff (1965), working in a Rogerian tradition, have dem-
onstrated that the greater the therapist's openness, the more likely the
patient will be to become self-disclosing.
While there has been general agreement about what it means for the
patient or client to be self-disclosing, it has not been equally clear which
of the therapist's verbal responses should be characterized as self-
disclosing. However, it has been generally agreed that self-disclosing
responses reflect some intimate aspect of the therapist's experience that
is revealed verbally to the patient (Chelune, 1975; Cozby, 1973; Jourard,
1968, 1971; Truax & Carkhuff, 1965). Thus, in response to the patient's
thoughts and behaviors as they unfold in the therapeutic interaction, the
therapist may reveal some personal reaction to the patient's verbaliza-
tions, or reveal something about his (the therapist's) life experiences
outside the therapeutic situation. While both classes of events may be
described as self-disclosure, it is important to distinguish between
them, since they are likely to have a differential impact on the therapeu-
tic process.
McCarthy and Betz (1978) proposed two types of therapist self-
disclosures. The first, defined as "self-involving disclosures," involved
those statements that were direct expressions of the therapist's feelings
or reactions to the statements and behaviors of the patient. The second,
"self-disclosing statements," referred to the past history or personal
experiences of the therapist. Subsequently, Nilsson, Strassberg, and
Bannon (1979) defined two categories of therapist self-disclosure. "Inter-
personal" self-disclosures referred to personal feelings about the pa-
Psychotherapy with Children and Adolescents 159

tient's problems or the therapeutic relationship, while "intrapersonal"

self-disclosures referred to statements about the therapist's life outside
the therapeutic relationship. The terms used in this latter definition
seem less awkward and confusing than the one offered by McCarthy
and Betz. In the discussion that follows we will use the terms "interper-
sonal" or "intra personal" self-disclosures to refer to the two classes of
therapist self-revelations.

Self-Disclosure in Psychoanalytic Psychotherapy

with Adults
Increased self-disclosure on the part of the adult patient has been
seen by practitioners of psychoanalytic psychotherapy as a sign of
therapeutic progress. The progressive self-exploration in which adult
patients examine their motives, relationships with others, fears, and life
choices, as well as their belief systems and values, has traditionally been
viewed as a fundamental aspect of the process of increased engagement
in psychotherapy. Clinicians have typically described patients as dem-
onstrating "greater insight" into the sources of their emotional diffi-
culties or as having a "greater awareness" of themselves, when they have
wanted to indicate how well the therapeutic work was progressing.
Similarly, they have used the adult patients' ability to speak more
openly about their emotional experiences, whether they are painful or
humiliating, as a barometer of therapeutic progress and as a sign of a
more trusting, viable therapeutic alliance. Thus, the adult patients' abil-
ity to become increasingly self-disclosing, to reveal more intimate and
important details of themselves to the therapist and significant others,
has been a widely accepted tenet of psychotherapeutic work. Empirical
work (Truax & Carkhuff, 1965) evaluating the outcome of the psycho-
therapeutic process has also supported the belief that the greater the
degree of self-exploration, the greater the potential for constructive per-
sonality change in that patient.
Psychoanalytic clinicians, depending upon their particular theoretical
orientation, give different weight to the therapist's self-disclosures. The
classical psychoanalytic position in working with adult patients has
argued that the therapist's behavior should be characterized by neu-
trality and abstinence (Freud, 1912, 1914; Langs, 1978). Psychoanalytic
practitioners working from this vantage point have considered self-
revealing comments on the part of the therapist as therapeutic errors
and a sign of countertransferential difficulties.
The psychoanalytic position of therapeutic neutrality stemmed
from Freud's (1912) recommendation that "the doctor should be opaque
160 Nicholas Papouchis

to his patients, and like a mirror, should show them nothing but what is
shown to him." This facilitated the projection of the patient's inner life
onto the person of the therapist (analyst), and contributed to the devel-
opment of the transference neurosis. The resolution of the resulting
psychic conflict was achieved through the process of the analyst's inter-
pretations, which led to insight and "working through." However, some
respected psychoanalytic practitioners (Stone, 1961; Greenson, 1969)
have indicated that there are situations that call for information about
the therapist as a person. Similarly, Schafer (1983), in describing the
classical analyst's empathic stance, noted that "there is always room in
the analytic work for courtesy, cordiality, gentleness, sincere empathic
participation and comment, and other such personal, though not so-
cially intimate, modes of relationship." While Schafer was describing the
analyst's departures from a position of neutrality, his remarks are
equally applicable to the question of self-disclosure.
In spite of these attempts to articulate the classical analyst's empa-
thic response to the patient, the emphasis on interpretation as the major
agent of therapeutic change has led most psychoanalysts working with
adults to pay insufficient attention to the relational issues that contrib-
ute to therapeutic change. In the discussion that follows I will refer to
these relational aspects of the therapeutic relationship as the inter-
personal-object relationship between therapist and patient. This term is
intended to capture both the style of relating and the inner psychologi-
cal makeup of both participants. I believe that this term encompasses
more than what Greenson and Wexler (1969) meant by the term "real
relationship." .
In the last 20 years, clinicians working with adult patients within
the classical tradition have begun to emphasize the reality aspects of the
therapeutic relationship. Greenson and Wexler's (1969) description of the
importance of the "real relationship" in therapy underscored the contri-
bution of the therapist's personality to the therapeutic alliance. They
noted that the rules of abstinence can be adhered to all too literally. They
suggested that the analyst feel free to offer an expression of compassion
or concern, or even an admission of technical error, when appropriate.
In the language of the present discussion, they encouraged "inter-
personal" self-disclosure on the part of the classical analyst. Similarly,
psychoanalytic clinicians working with more severely disturbed pa-
tients have emphasized the importance of modifying the therapist's
neutral stance in working with more disturbed patients whose lack of
psychic organization left them unable to tolerate the therapist's dis-
tance. (Arieti, 1974; Meissner, 1986; Pine, 1985; Winnicott, 1965). Their
recommendations underscored the importance of the interpersonal-
object relationship between therapist and patient as the foundation that
Psychotherapy with Children and Adolescents 161

facilitated the development of the therapeutic alliance, and which pro-

vided, to use Winnicott's term (1965), a "holding environment" for the
difficult psychotherapeutic process which ensued.
The interpersonal-object relationship in psychotherapy and psy-
choanalysis is important for all patients, not simply more disturbed
patients. Most clinicians fondly remember many of the interpersonal
attributes of their own analysts. They also vividly remember the poi-
gnant moments when the analyst revealed himself in a moment of par-
ticularly intimate relatedness.
Other therapeutic positions have lent further support to the argu-
ment of the therapist's interpersonal-object relational importance. The
work of the British Object Relations School, particularly the seminal
contributions of Fairbairn (1952), Guntrip (1971), and Winnicott (1965),
have all emphasized the importance of the real relationship between
therapist and patient. Each has cogently argued for the importance of
the new object-relational experience the adult patient has with his an-
alyst. From their perspective, the psychotherapeutic experience is not
simply a reliving of the patient's old object relationships. It is more
accurately conceptualized as a reworking of the old conflicts in the
safety of a new growth-producing relationship, which allows for a new
experience that had not been previously possible. In this context, selec-
tive "interpersonal" self-disclosure on the part of the analyst facilitates
the interpersonal-object relationship that develops by helping more
clearly to define the analyst as a new object.
Sullivan's (1953) interpersonal theory has also underlined the thera-
pist's continued and repeated personal cqntribution to the therapeutic
interaction. His conceptualization of the therapist's role has been suc-
cinctly captured in his description of the therapist's involvement as one
of "participant observation." In the interpersonal model one cannot par-
ticipate without revealing some aspect of the self (often quite directly),
and one cannot observe the therapeutic interaction without observing
some aspect of the self in interaction.
What I wish to highlight here is Sullivan's view of the analyst as an
ongoing contributor to the patient's experience. This does not mean that
the interpersonal analyst is by definition interactive. That is more a
matter of personal style. I am also not suggesting that the interpersonal
analyst be more self-disclosing. That too is a matter of individual style,
and not theoretical orientation. In fact, from this author's interpersonal
perspective, "intrapersonal" self-disclosures, that is, statements about
the analyst's personal life outside the treatment relationship, are rarely
indicated, and very likely to be signs of countertransference difficulties
to be examined. I include here the analyst'S responses to the seemingly
innocuous impersonal questions that patients ask as well. Further, I
162 Nicholas Papouchis

would argue that in psychotherapy with adult patients the therapist

should not make more than infrequent, selective use of "interpersonal"
self-disclosure. More than this dilutes the meaning of these interven-
tions, and interferes with the analyst's ability to help the patient differ-
entiate his transferential distortions from the analyst's behavior.
Self-disclosure on the part of the analyst would seem to be inti-
mately related to his conception of countertransference. The classical
analytic position has traditionally viewed countertransference as an un-
wanted contribution of the analyst's unresolved psychic conflicts (Mar-
shall, 1988). More recently within this tradition (Renik, 1986), there has
been an increasing tendency to see countertransference as a useful tool,
although there is still controversy as to how it should be used. Thus,
while acknowledged as an important aspect of the therapeutic process,
its disclosure in the therapeutic interaction has not been widely ac-
cepted. In contrast, the interpersonal analytic position espoused by
Epstein and Feiner (1979) and Marshall and Marshall (1988), among
others, has more consistently argued for the use of countertransference
feelings as internal cues to the patient's experience, and supported the
selective disclosure of these feelings to the patient. Springmann (1986),
for example, has argued that the understanding of client-induced coun-
tertransference is an integral part of psychotherapy and that it should be
revealed to the patient at the appropriate times. To the extent that "inter-
personal" self-disclosure may be seen as following from the analyst's
view of the meaning of his countertransference to the patient, it is clear
from the above discussion that analysts of the interpersonal school are
less likely to be hesitant to discuss their reactions to the patient.
In sum, it is this author's position that self-disclosure on the part of
the therapist has been accepted as an integral part of the therapeutic
relationship by all schools of psychoanalytic thought. Each of the
schools, however, has different theoretical conceptions as to how the
issues of self-disclosure are to be viewed, the conditions under which
they come about, and how they are to be addressed. The major question
that will continue to be addressed in work with adults is to what extent
and under what conditions should the adult psychotherapist be self-
disclosing. With this brief summary as a point of contrast, let us now
turn to the issue of self-disclosure with adolescents and children.

Self-Disclosure with Children and Adolescents:

A Developmental Perspective
Self-Disclosure in Psychotherapy with Children
The issue of self-disclosure must be viewed from a different vantage
point when we work therapeutkally with adolescents and children.
Psychotherapy with Children and Adolescents 163

Here the developmental tasks and needs of our younger patients are an
important determinant in understanding how the phenomenon of self-
disclosure manifests itself in both patient and therapist. For example, it
is not always possible, nor even desirable, for our younger patients to be
self-disclosing in the way that our adult patients are. Latency-age chil-
dren express themselves symbolically through activity as well as
through language. Thus, the child therapist, working with his patient in
a combination of verbal and play therapy, looks for the resolution of
psychic conflicts in the child's play, and in descriptions of his behavior
from teachers and parents, rather than solely through the child's verbal
productions. Premature verbal disclosure of psychic conflict, even when
possible, may tax the child's developing ego resources and impede
rather than facilitate future ego development.
The child therapist must be aware of the developmental tasks that
the latency age child faces. Each of these tasks requires the child's in-
creasing ego mastery of the issues he is faced with. Therapeutic efforts
are directed toward the removal of the obstacles that interfere with
mastery of these tasks, and facilitating the child's development through
periods of disequilibrium as these tasks are mastered (Pine, 1985). The
child therapist, aware of the ways in which his child patient's premature
self-disclosures may represent a threat to a developing sense of self, and
the child's ego resources, modifies the degree to which the child's self-
discovery proceeds.
Let us articulate some of the important tasks of the latency period
before proceeding further:
1. Increasing independence from parents, including opportunities
for other objects of authority with whom to identify.
2. The development of peer relations, including the mastery of is-
sues of competition and cooperation in work and play.
3. Increased ego functioning manifested in greater defensive con-
trol over instinctual life, adaptation to reality, and the capacity
for intellectual mastery of school-based learning.
To illustrate the importance of this knowledge in working with chil-
dren, let us specify the age of a hypothetical patient as six years old. The
child at this age, early in latency, is concerned with repression of pre-
oedipal issues, and is struggling with the mastery of his inner life (Born-
stein, 1951). Premature self-disclosure of sexual or aggressive material
thus represents a threat to the child's developing psychic equilibrium.
Further, the child, at this age, may be using language which is still too
intimately tied to emotional experience. Words may be experienced as
equivalent to the actions they describe. From this perspective, the thera-
pist's insistence on continued exploration of dynamic issues represents a
distinct threat to the child, and is to be carefully avoided.
164 Nicholas Papouchis

The Therapist's Role and the Issue of Self-Disclosure with Children

Anna Freud has emphasized how the child's developing object rela-
tionships demand that the child therapist or analyst must be anything
but impersonal or shadowy (1976). The latency-age child, like the adoles-
cent, still has his original objects present. The parents exist, not only in
fantasy, as they do with adult patients, but continue to determine the
child's gratifications and disappointments in his everyday life. Thus, the
analyst enters the therapeutic relationship as a new object and the devel-
oping interpersonal-object relationship that ensues contributes signifi-
cantly to the child's development.
In contrast to Melanie Klein's position regarding the interpretation
of transference, Anna Freud (1976) argues that the behavior of the an-
alyst of children is not solely intended to produce a transference that can
be interpreted. Instead, she notes that the person of the analyst is of
great interest to the child, whom he (the child) endows with a variety of
attractive and interesting qualities. Further, the analyst's educational
efforts, and setting of limits informs the child what the analyst sanc-
tions or disapproves of. Thus, as with the adolescent therapist, the child
therapist reveals himself, and his belief system in his efforts at educa-
tion or limit setting. These behaviors are invariably self-disclosing.
Other child therapists (Ross, 1964; Ginott, 1964) have also pointed
out that the child's questions must be responded to differently than an
adult's. Children's questions are often centered on trying to find their
place in the world, and who belongs where. The therapist who deflects
their questions by interpreting the unconscious reasons for their asking,
demonstrates a lack of interest in these concerns, and may interfere with
the child's ability to master reality. Although it is useful to give the child
an opportunity to explore their fantasies about the way they "would like
things to be," the therapist should also respond to questions in a man-
ner that is simple and direct (Ross, 1964).
Similarly, the therapist who intersperses his interpretative inquiries
about the meaning of a child's curiosity about the therapist with some
brief and general answers to the child's questions, addresses both the
unconscious and reality-oriented meaning of the child's concerns (Gin-
ott, 1964). As the treatment relationship develops, the therapist may also
be able to respond directly to the child's inquiries about his mood. To the
extent that the therapist comfortably responds to direct questions about
countertransferential responses that are evident in the analyst's behav-
ior, he enhances the child's faith in the therapist's reliability, and helps
the child to realize that some temporary problem in the relationship
does not interfere with the core of the interpersonal-object relationship
between them (Colm, 1964). These self-disclosures also support the
child's developing ability to experience feelings of ambivalence toward
Psychotherapy with Children and Adolescents 165

the significant people in his life. It should also be emphasized here, that
those feelings which the analyst experiences as the result of unresolved
inner conflicts are not part of the self-disclosure.
Let us turn next to the issues of self-disclosure in therapeutic work
with adolescents. Issues of self-disclosure with this population become
more complex because of the complexity of the developmental tasks
which the adolescent faces.

Self-Disclosure and the Adolescent Patient

The early adolescent patient, unlike the latency age child, has devel-
oped the capacity to represent psychic issues symbolically in a verbal
manner. Yet, he may be equally unprepared to be verbally self-disclosing.
The emergence of drive activity at puberty, the dramatic physical
changes that ensue, and the confused, and at times embarrassed sense
of inner states of feeling often make the early adolescent acutely sensi-
tive to what is private and what is public. Adolescents are also acutely
sensitive to issues which threaten their desire for autonomy, and which
reawaken dependent wishes for support from parents. It is often not
until mid-to-Iate adolescence when ego functioning and the capacity for
formal operational thought (Flavell, 1963) have developed sufficiently,
that adolescents feel some sense of mastery over their inner life. At this
time in development, interpersonal skills have developed to the point
where heterosexual relationships have begun. The adolescent has be-
gun to develop some confidence in his sexual identity and more intimate
verbal self-disclosure may become possible without representing a
threat to their sense of self.
Even at this point in the adolescent's development, he is rarely able
to approximate the sustained self-examination that one sees with adult
patients. The therapist who naively follows an adolescent's open self-
revealing discussion in a therapy session, without being aware of the
threat that this material presents to the patient, is often surprised when
his adolescent patient misses the next session. Or, if the material has
been too threatening, the patient decides to terminate therapy. This can
often happen without the adolescent appearing to be aware of how
threatening the experience of self-disclosure was. From this develop-
mental perspective, it is important for the therapist to know that verbal
self-disclosure on the part of his younger patient may not always be a
sign of therapeutic progress, but rather may represent a danger that
threatens to disrupt a developing therapeutic alliance.
John, an articulate 16-year-old adolescent, had spent the previous session
describing with considerable clarity how he felt his father was competing
with him, and favored his younger brother. He began the next session by
166 Nicholas Papouchis

saying that he had thought about discontinuing therapy, but he wasn't sure
why. When his therapist pointed out to him that he had talked a great deal
about angry feelings toward his father in the previous session, he responded
by saying that he had felt guilty about complaining so angrily, but had not
connected these guilty feelings with his thoughts of stopping therapy. The
therapist then slowly began to help John face and accept the anger which he
avoided in a number of other interpersonal situations.
The therapist often helps the adolescent patient by indicating that
there are some things "that may be too upsetting to talk about right
now." Or that the ability to understand the nature of what they are
feeling may proceed at a slower pace. This is not to say that the adoles-
cent therapist should help the patient avoid self-disclosing. Instead, the
therapist monitors the impact of all self-disclosures on the patient's atti-
tudes toward therapy.
Before proceeding to a discussion of the therapist's self-disclosure
with adolescents, it will be helpful to review briefly some of the major
developmental tasks of adolescence. Blos (1979) has described the period
of adolescence as "the second separation-individuation process."
Among the major developmental tasks of this developmental period are:
1. Intrapsychic separation from the family of origin.
2. Mastery of the biological event of puberty.with the necessary
changes in ego functioning, and the initial mastery and accep-
tance of sexuality.
3. The intimately related tasks of the development of a sense of
identity and an ego-ideal.
The therapist working intensively with adolescents will invariably be
forced to help his adolescent patient deal with all these issues. More
often than not, they are going on simultaneously, and the therapist has
to choose which of them to work on at that moment. This usually de-
pends upon which of the issues is highest on the adolescent's list of
psychic priorities. The therapist often finds himself helping his patient
deal with feeling overwhelmed, while respectfully encouraging his pa-
tient's developing ability to cope with the concrete problem at hand.
Similarly, the therapist may deliberately not interpret what he knows to
be a deeply conflictual issue, in favor of supporting the adolescent's
resourceful autonomous coping with that issue. This is not to say that
the adolescent therapist avoids the interpretation of conflictual material.
Rather, that his primary focus is more likely to be on the interpretation of
defenses against affects which interfere with ego development (Meeks,
1986).
Sam, a depressed 17-year-old boy, was constantly fighting with his parents.
Many of his disputes were with his mother to whom he had a decidedly
erotic attachment. His fights were thus designed to distance him from an
Psychotherapy with Children and Adolescents 167

attachment which he felt to be both overwhelming and highly sexualized.

Interpretive work was directed toward understanding how his fights were
designed to ward off a feeling of powerlessness, and avoided any reference to
sexual feelings.

The Therapist's Self-Disclosure with Adolescents

The therapist who works with adolescents is invariably more self-
disclosing than the therapist working with adults. The intrapsychic
separation from parents that adolescents have begun at puberty leads
them to seek out new adult objects with whom to identify. At the same
time, the adolescents' intense discomfort and mistrust of any dependent
relationship with adults requires a different therapeutic stance on the
part of the therapist. Their need is for an adult who can understand
them on their terms without losing their status as an adult. Simul-
taneously, that adult (the therapist) has to demonstrate continuously
that he is interested in helping the adolescent establish his autonomy,
not in recreating the adolescent's dependent relationship with the par-
ents. The therapist, often sought out as an alternative adult model to the
parents, must be prepared to be subjected to careful scrutiny from his
adolescent patient who evaluates and questions his behavior with an
intensity not found in the adult or child patient.
The adolescent who comes to psychotherapy suspicious of adults,
and resistant to treatment, is likely to become increasingly wary of the
therapist who avoids direct questions and relies on technical skills to
avoid inquiries about herself. In contrast, the therapist who treats the
adolescent's questions respectfully and thoughtfully and without undue
anxiety, demonstrates to the adolescent that the therapy office is a place
where honesty and frankness are valued. These conditions make the
interpersonal-object relationship between therapist and adolescent a
critical factor in the therapeutic process. To use Bowlby's (1969) lan-
guage, the developing attachment to the therapist makes the under-
standing of the analysis of transference possible.
One of the effects of the therapeutic interactions that follow is that
the therapist employs a style of relating that is likely to result in more
"interpersonal" self-disclosure than is usually found in work with chil-
dren and adults. This does not mean that the therapist of adolescents
abandons his interpretive stance, or that the therapist is excessively self-
disclosing. In fact, the therapist's more interpersonal, interactive style is
likely to enhance the impact of interpretations when they are offered,
and to facilitate identification with the therapist's analytic posture to-
ward the patient's problems. The therapist's empathic understanding of
the adolescent's developmental tasks and the difficulties they entail
168 Nicholas Papouchis

make him a more attractive attachment figure. The person of the adoles-
cent therapist is also available for the adolescent to discuss ideas with,
disagree and argue with, and to accept support from, since that support
need not threaten the adolescents' fragile sense of autonomy.
Adatto (1966) has used the term "special friend" to describe the
nature of the relationship between adolescent and therapist described
above. Clinicians have often described the relationship as avuncular, to
characterize the important interpersonal-object relationship that de-
velops between them. Let me also emphasize that the therapist does not
offer himself as a replacement for the lost relationship with the parents.
To the contrary, the therapist should actively interpret his adolescent
patient's efforts to place him in a parental role (Meeks, 1986). Instead,
the therapist, depending upon the age of the adolescent, is a trusted
adult who stands somewhere between the adolescent's struggle to hold
onto wishes to remain a child, and his drive to become an autonomous
individual on the way to adulthood.
To do this the therapist must present himself as an authentic, caring
presence with whom both aspects of the struggle for autonomy may be
discussed without unduly threatening the adolescent's self-esteem.
When the therapist offers evasive responses to direct questions, refuses
to help solve real problems in the life of the adolescent, or continues to
insist on focusing only on the unconscious meaning of the adolescent's
statements, the adolescent's resistance stiffens and the development of a
therapeutic alliance is impeded. Instead, the therapist who demon-
strates his support for the adolescent's interest in expanding his ego's
mastery of both his inner life and reality, and his efforts to develop a
sense of identity, can become a trusted ally. From this perspective,
"interpersonal" self-disclosing statements from the therapist help to
demonstrate to the adolescent that he or she is to be trusted.
We are taught that with adult patients all questions about the thera-
pist are grist for the mill. In contrast, with adolescents and children, one
is more likely to respond directly to questions that do not seem to be
related to dynamic issues. Thus, the therapist who answers an early
adolescent's question as to whether they (the therapist) had hobbies as a
teenager, is more likely to be trusted than the therapist who feels com-
pelled to "analyze" all such questions. Similarly, the therapist who di-
rectly and comfortably answers an adolescent patient's question about
his life, and then inquires about the nature of the adolescent's curiosity
in this area, is more likely to facilitate true self-examination in his ado-
lescent patient, than the therapist who carefully works at showing the
patient that his questions have dynamic significance.
Sheila, a 17-year-old black adolescent, had recently been discharged from the
hospital, and was living again in a foster home. Several months later, during
Psychotherapy with Children and Adolescents 169

one of her outpatient visits, as she talked with an air of casualness about her
relationship with her parents, she noticed that her therapist had tears in his
eyes. After summoning her courage, she asked the therapist why he seemed
to be crying. He replied simply that her description of her life had made him
sad. She then began to weep openly, and reported later that it was one of the
few times she had been able to cry about the fact that her mother had been in
a mental hospital most of her life, and that she rarely saw her alcoholic father.
From that time on, she called her therapist the "feeling doctor."

The Therapeutic Alliance and Self-Disclosure

From the outset of the treatment, the therapist's style of relating to
the adolescent patient is one of the most important factors in engaging
the patient and facilitating the development of a therapeutic alliance
(Adatto, 1966; Kessler, 1979; Papouchis, 1982). Many authors (Holmes,
1964; Meeks, 1985; Weiner, 1970) have argued that a natural, informal
style combined with the readiness and willingness to participate ac-
tively and directly (to be willing to be "interpersonally" self-disclosing)
in therapeutic interactions contributes to the adolescent's ability to trust
the therapist. Please note that I am not speaking here of a pseudo-easy-
going, artificial role adopted by the therapist to convince his adolescent
patient that he can be trusted. The adolescent's sensitivity to such a
manipulative stance would in all likelihood doom the therapy from the
outset. Both Anthony (1969) and Meeks (1986) have spoken to the coun-
tertransference dangers that work with adolescents involves. I am refer-
ring instead to someone whose style is genuinely natural; who is not
assuming a therapeutic stance in order to seduce the adolescent into a
treatment relationship. I would also like to add, as I have stated else-
where (Papouchis, 1982), thC).t this style of relating cuts across a variety
of personality types, and many analysts who are thoughtful and quiet
when working with adults, are quite comfortable interacting sponta-
neously and directly with their adolescent patients.
Perhaps this style of relating is most comfortable to clinicians work-
ing from within a developmental perspective. As Pine (1985) has ar-
gued, research and knowledge of developmental issues may effect the
practice of psychoanalysis and psychotherapy by influencing the lan-
guage that the analyst uses in speaking to the patient. Or it may help
him (the analyst) more precisely to describe the phenomena to which
that language refers. In either case, it seems clear that a language and
style of communication close to the adolescent patient's concrete experi-
ence is likely to be maximally evocative.
In describing the adolescent therapist's style of relating, Meeks
(1985), Holmes (1964), and Weiner (1970) have argued that authenticity
and genuineness on the therapist's part lead to the therapist revealing
170 Nicholas Papouchis

more of himself or herself in the therapeutic interactions. It is difficult to

be direct and spontaneous without being in a position where the thera-
peutic interactions require greater degrees of self-disclosures on the part
of the therapist. The therapist of the adolescent thus consistently reveals
more of himself than he would to his adult or child patient.
Holmes (1964) has characterized this style of interacting as one
which involves "abnormal candor." He notes that:
The therapist reveals much of his personality for two reasons: (1) he can't
hide it from the adolescent anyway; and (2) there is no good reason to try to
hide it even if it were possible. The adolescent is able to tell too much about
us even when it is our intention to tell him nothing at all. Our efforts to
operate as emotional technicians of some sort are transparent to him; they
only increase his embarrassment and uneasiness in a situation that is already
strained at best. A conversational style which would appear to the average
adult to be one of "abnormal candor" contributes much to the atmosphere in
which the adolescent can work best. This will do far more than an explana-
tion of the "basic rule" toward making it possible for him to let us know what
is going on in his mind. He will approach the work of therapy according to
his therapist's lead. (p. 103)
As indicated above, one way to conceptualize this type of interac-
tion is to understand it as one that is developmentally appropriate to the
needs of the patient. The directedness of expression and style of relating
employed by the therapist have the effect of meeting the adolescent in a
communicative domain that is familiar to him and which encourages his
view of the therapist as a potential ally.

The Adolescent Therapist as an Object of Identification

Adolescents are intensely curious about the way the adult world
works. In fact, although they are often among the most outspoken
critics of the existing social order, they are also anxious to find their
place in it and search for adult models with whom to identify (Meeks,
1986). Curious about the world, anxious to find concrete solutions to
problems with which they are faced, they often look to these adult
models and to the person of their therapist for information about how to
deal with these issues. Thus, the therapist's attitude about the issue or
his stance about the importance of the problem quietly influences the
adolescent's perspective on a particular issue. Beyond the implicit ques-
tions, there are also the less frequent explicit questions about how the
therapist would deal with these issues. The selected "interpersonal"
and less common "intrapersonal" self-disclosures thus help the adoles-
cents to cope with their confusion about the issues at hand.
Jim, an articulate, 17-year-old high school senior, was quite depressed about
Psychotherapy with Children and Adolescents 171

a love relationship he was having. His parents had told him that he should
forget about the relationship with this younger girl. However, he was unable
to do so and continued to pine for her. His therapist, instead of analyzing his
inability to do so, said simply. "In my day, the pain you are feeling over this
relationship was thought of as one of the painful introductions to adult-
hood." Jim relaxed noticeably and in subsequent sessions was able to begin
to talk about how difficult it had always been for him to end relationships
with people, no matter how problematic they were.

In this manner, self-disclosure contributes to the adolescent's iden-

tification with aspects of the therapist's personality or attitude about the
world (Adatto, 1966; Hendrick, 1988; Giovacchini, 1974; Papouchis,
1982). Selected aspects of the therapist's personality are then available to
contribute to the development of the adolescent's ego ideal. Self-
disclosure also prevents the exaggerated idealizations that may develop
from the adolescent's projection of omnipotence onto the therapist. This
is not to say that some degree of idealization is not an inevitable aspect of
the therapeutic process. Rather, I would argue that it is important to
avoid the excessive idealization that may interfere with an adolescent's
ability to experiment with problem solving because of his mistaken
belief in the existence of a "right" answer to a problem. It is essential
therefore that the therapist convey to his patient that his way of solving a
particular problem or way of looking at a particular issue is only one of a
number of possible alternatives. It is equally important that the thera-
pist emphasize that the point of view he presently adopts is one that
developed after considerable reexamination over some period of time.
The absence of omnipotence in the therapist's stance thus offers the
adolescent the opportunity to identify selectively with some of the
therapist's ways of coping with the world, and enhances the adolescent's
ego functioning, without undermining his autonomy or self-esteem.
To do this the therapist must also respectfully encourage and ac-
knowledge the adolescent's unique and often creative ways of coping
with the world. While the adolescent may look to the therapist to help
fill the void created by his intrapsychic disengagement from his parents,
he is not looking for parental substitutes with whom he can recreate the
same dependent relationship. Unlike the parent, the therapist must
demonstrate to the adolescent that he does not have a narcissistic invest-
ment in the adolescent's following his advice or way of seeing things,
and respects the adolescent's differences of opinion.
It is critical that the therapist demonstrate this by a willingness to
let the adolescent work things out on his own. Unlike the concerned but
controlling parent who must "help" the adolescent work out their prob-
lems, the effective therapist of adolescents acknowledges that there are a
number of different ways to solve problems, and respects the fact that
the adolescent's task is to discover those that work most effectively
for him.
172 Nicholas Papouchis

It is equally important that the therapist's comfort with self-

disclosure involves a willingness to examine her own beliefs as they
come under scrutiny, especially to acknowledge when those beliefs
might be wrong. Authentic self-disclosure that leads to greater interper-
sonal intimacy and promotes therapeutic progress thus involves a readi-
ness to acknowledge mistakes, and to listen with respect to the opinion
of the adolescent with whom one is working (Giovacchini, 1974).

Summary

In summary, it is my opinion that self-disclosure on the part of the

child or adolescent represents a greater threat to the developing ego
than it does to the adult. Both children and adolescents must focus their
ego resources on mastering the developmental tasks with which they
are faced. Premature uncovering of unconscious conflict may represent
a serious threat to the ego's ability to maintain psychic equilibrium. As a
result, the therapist who works with this population must constantly
monitor the impact of the patient's self-disclosures on the therapeutic
alliance, while helping him gain greater ego mastery of the intrapsychic
conflicts with which he is faced.
The therapist who works with this population is more likely to be
self-disclosing than the therapist who works with adults. I have argued
that the interpersonal-object relationship between patient and therapist
provides a crucial foundation for the psychotherapeutic process. The
nature of this relationship is different with children and adolescents
than with adults, since it occurs while the object relationship with the
parents is ongoing. As a result, the child and adolescent therapist is
more of a real figure in the life of her patients. This does not minimize
the importance of work in the transference. Instead, it makes the thera-
peutic work more complex. Selective self-disclosures on the part of the
child and adolescent therapist facilitate the therapeutic interpersonal-
object relationship, and contribute to the child and adolescent's oppor-
tunity to identify with aspects of the therapist's personality.

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Renik, 0. (1986). Countertransference in theory and practice. Journal of the American Psycho-
analytic Association, 34(3):699-708.
Ross, A.O. (1964). Techniques of therapy. In Mary R. Haworth, Ed., Child psychotherapy:
Practice and theory. New York: Basic Books.
Schafer, R. (1983). The analytic attitude. New York: Basic Books.
Springmann, R.R. (1986). Countertransference: Clarifications in supervision. Contempor-
ary Psychoanalysis, 22, 256-277.
Stone, 1. (1961). The psychoanalytic situation. New York: International Universities Press.
Sullivan, H.S. (1953). The interpersonal theory of psychiatry. New York: w.w. Norton.
Truax, C.B., Carkhuff, R.R. (1965). Client and therapist transparency in the psycho-
therapeutic encounter. Journal of Counseling Psychology, 12, 3-8.
Weiner, I. (1970). Psychological disturbance in adolescence. New York: Wiley-Interscience.
Winnicott, D. W. (1965). The maturational processes and the facilitating environment. New York:
International Universities Press.
 12
Self-Disclosure in Psychotherapy
WORKING WITH OLDER ADULTS

Lisa R. Greenberg

Introduction
A factory worker in her mid-60s recently came to me for treatment. She
showed many symptoms of agitated depression and described herself as
"always" having been extremely "nervous." She told me that it had
always been her strategy to try to "erase" her feelings. Ten minutes
into her first session, she hesitated in response to a question I had
asked about her daughter, and then said, "Well, there was an inci-
dent ... maybe subconsciously ... no, let's go on." When I encouraged
her to tell me what she was thinking, she reported an event that had
occurred 20 years earlier, during which she had failed to protect her
daughter as she thought proper. She was able to begin to see that her
attempts to push aside her guilt had not worked for her, and to consider
various ways in which her feelings about the incident had affected both
her relationship with her daughter and her own sense of herself. She left
the session somewhat teary but greatly relieved and committed to con-
tinuing therapy.
Like many other distressed older people, she had paid such a high
price for so long for trying to minimize her own experience that the
merest taste of a relationship in which her feelings were valued was
enough to lead her to reveal highly personal material in a helpful, posi-
tive way. Is this woman unusual? Do older people as a group self-
disclose easily and effectively, or hesitantly and with no clear results?

Lisa R. Greenberg • 428 Franklin Avenue, Nutley, New Jersey 07110.

175
176 Lisa R. Greenberg

Can those who do not disclose easily be helped to learn to do so? In a

volume on the role of self-disclosure in psychotherapy, need the elderly
even be considered as a separate group, or are the risks and benefits of
self-disclosure, and even the content of what is disclosed, exactly the
same as for others?

Role of Self-Disclosure for Older People

In considering the role of self-disclosure in the psychotherapeutic
treatment of older adults, defining the concept of "self-disclosure" is an
important first step. For the purposes of this chapter, I will use the term
to refer to the process of verbally revealing to another information about
oneself that is at least somewhat personal in nature.
Hatfield (1982) writes, "epidemiologists have accumulated an abun-
dance of evidence that intimacy and self-disclosure help people main-
tain their mental and physical health," while also identifying the risks
of too much disclosure. Do these conclusions, derived from various
studies with the general population, apply to the elderly?
The answer appears to be yes, but this conclusion is more tentative
and more ambiguous than might be imagined.
In examining the work of those who argue for the importance of
intimate, self-disclosing relationships for the elderly, Lowenthal and Ha-
ven's (1968) well-known study of San Francisco residents over age 60 is a
good starting point. As part of a much larger work, they asked the
question, "Is there anyone in particular you confide in or talk to about
yourself or your problems?" Their hypothesis, that having at least one
close personal relationship might serve as a buffer against such age-
linked social losses as role loss, reduction of social interaction, widow-
hood, and retirement, was confirmed. They found, for example, that a
person who has been widowed within seven years and had a confidant
had even higher morale than a married person without a confidant. The
only crisis in which having a confidant did not protect a subject'S morale
was physical illness: the elderly subjects who were or had recently been
ill were found to be seriously depressed, regardless of whether they had
a confidant. The authors summarize:
The maintenance of a stable intimate relationship is more closely associated
with good mental health and higher morale than is high social interaction or
role status, or stability in interaction and role. Similarly, the loss of a confi-
dant has a more deleterious effect on morale, though not on mental health
status, than does a reduction in either of the other two social measures.
(p. 400)
Working with Older Adults 177

Lowenthal and Haven also looked at both the characteristics of

those who had confidants and the identity of the confidants themselves.
They identified women as more likely than men to have confidants, and
married people as more likely than widowed, who were in turn more
likely than single people to have confidants. Among those who did have
confidants, the confidant was equally likely to be spouse, child, or
friend, with men much more likely to identify their spouse as confidant
than women. The likelihood of having a confidant was greater for those
above the mean socioeconomically, and for those with a more complex
social life.
Murphy's (1982) work generated similar conclusions. She compared
depressed and normal elderly people in the general population using
several measures, including a version of the Bedford College Life Events
and Difficulties Interview modified for the elderly, which allowed a
rating of depth of intimacy. She found the lack of a confiding relationship
to be a factor increasing one's vulnerability to depression. Like Low-
enthal and Haven, Murphy found most elderly subjects to be "remarka-
bly cheerful," even in the face of considerable difficulties, with the
exception only of those who lacked a confidant. She notes that it is not
those who are lifelong social isolates by choice who have difficulty, but
those who have tried and failed to establish good relationships. It is also
interesting that those whose confidants were seen as little as every two
to three weeks were as protected against depression as those who
shared a household with a confidant. This suggested to Murphy that
the crucial factor protecting against depression in the elderly is the ca-
pacity for intimacy, which she felt to be a lifelong personality trait.
Unlike Lowenthal and Haven, she did not believe that intimacy was
related to social class.
In a later study (1985), Murphy compared the ratings of intimacy of
interpersonal relationships for elderly subjects who did and did not
recover from depressive episodes for a year. She found that those who
had recovered were significantly more likely to report a positive change
in the quality of their intimate relationships than were those who had
either remained continuously depressed or who had recovered and re-
lapsed. While cause and effect are obviously unclear here, a statement
about the value of confiding relationships for at least some elderly seems
to be implied.
Some work of my own is also relevant here (Greenberg, 1982). As
part of a study designed primarily to explore life satisfaction among
elderly female homemakers and retirees, a structured interview and the
Osgood Semantic Differential were administered to 60 women ranging
in age from 70 to 79. Of particular interest in this context is that, while
many of these women spoke with pleasure of a sense of freedom, a joy
178 Lisa R. Greenberg

in the feeling that "I do what I feel like doing" after a lifetime of caring
for others, many others expressed the flip side of this and spoke elo-
quently of feelings of loneliness and isolation. Many widows spoke with
sadness of not having a spouse, or any relationship with a man, while
others specifically mentioned the pain of not feeling close to anybody.
Several felt that developing new friendships was harder in their old age
than it had been at other points in their lives. All these concerns seemed
to be expressions of deeply felt desires for intimate, confiding relation-
ships. While the lack of these relationships had not led any of these
women to become depressed or in any other way symptomatic, the
frequency and eloquence with which this issue was mentioned by wom-
en who were otherwise reluctant to acknowledge painful feelings is
indeed a strong statement, spoken by older people themselves, of the
felt need for confiding relationships in older peoples' lives.
Indications of the importance of relationships in which self-
disclosure plays an important part come from other sources as welt
including studies on the importance of reminiscence for the elderly.
Reminiscing, defined by McMahon and Rhudick (1961) as the "act or
habit of thinking about or relating past experiences, especially those
considered most personally significant" (p. 292), can be either an inter-
nal or an interpersonal process, but, when interpersonat seems likely
to be an act of self-disclosure. McMahon and Rhudick's finding, that
reminiscing serves many positive functions for the elderly, including
maintaining self-esteem, bolstering a sense of identity, and working
through loss, again argues for the value of self-disclosure for the elderly.
Lewis and Butler (1974) formalized the process of reminiscing in the
elderly with their "life-review therapy." They believe that, particularly
for people in their 60s, a process of "life-review" occurs, in which the
older person looks back over his or her life, reviews and resolves con-
flicts and comes to terms with both past and present. They believe that
life review can take many forms, but noted that it is greatly enhanced by
the presence of listeners, in which case it becomes a process of self-
disclosure, which the authors clearly believe has value.
As suggested, however, the notion that confiding relationships are
of value for the elderly is not universally held. Jerrome's (1981) stU9.y of
friendship and aging among middle-class British women is an example.
Her research was anthropological in nature, and consisted of depth
interviews and participant observation. Her 66 subjects ranged in age
from their late 50s to mid-80s. Most relevant to this work is her conclu-
sion that the main need in friendships among the elderly women she
studied seemed to be for companionship in a pleasurable activity. She
stated specifically that neither the exchange of help nor the exchange of
confidences seemed important in these friendships. The relationships
Working with Older Adults 179

she described appeared to be close and sustaining ones for the people
involved, and included much time spent together in a wide range of
mutually enjoyable activities, including shopping, gardening, card
playing, and, in particular, eating and drinking. Self-disclosure, how-
ever, simply did not appear to be an important component, at least as
observed and reported by Jerrome.
Andersson's (1985) work provides some support for Jerrome's con-
clusions. Working in Stockholm, he designed and studied an interven-
tion program for a group of elderly women who described themselves as
lonely. The intervention consisted of neighborhood groups with be-
tween three and five members who met four times, the first and last time
with a home-help assistant present. Each group meeting was a discus-
sion of a particular topic. Interviews held six months after the meetings
showed that participating subjects had less feelings of loneliness and
meaninglessness, more social contacts, higher self-esteem, greater ability
to trust, and lower blood pressure than before the program. There was,
however, no change regarding the availability of a close friend or confidant.
In considering his results, Andersson cited Jerrome's breakdown of
friendship into three levels of intimacy, the first being shared activity,
the second, reciprocal help, and the third, an exchange of confidences.
Referring to the work of Jerrome and others, he hypothesized that under
the normal circumstances of daily life, the optimal level of intimacy
appears to be the exchange of reciprocal help. The next level of intimacy,
the exchange of confidences, or self-disclosure, he proposed as promot-
ing adaptation only in times of social loss. Andersson, however, did not
consider that such losses do come along particularly frequently in the
lives of elderly people, and therefore, the presence of a confiding rela-
tionship could be viewed as protective for all older people. It should also
be noted that the findings of both Jerrome and Andersson seem to be in
some contrast with my own; the women who described to me feelings of
loneliness seemed clearly to be seeking, not companions with whom to
share particular activities or exchange help, but true friends with whom
to share themselves.
Emery and Lesher's (1982) paper on the treatment of depression in
the elderly is also germane. This work was identified as part of a series of
depression-treatment outcome studies at the University of Southern
California's Andrus Gerontology Centers, but appears to be anecdotal in
nature. This work supports the idea that self-disclosure is not univer-
sally of value to the eldefly, but may be helpful under certain conditions.
These authors came at the problem from another angle, claiming that the
value of self-disclosure for a particular individual depends not on that
person's circumstances at a given time, but on personality. Specifically,
they felt that the elderly can be divided into two personality modes,
180 Lisa R. Greenberg

dependent and autonomous, and that these modes influence the causes,
symptomatology, and appropriate treatment for a particular individual's
depression. They saw the dependent elderly as introspective and eager
to discuss feelings. For this group, despite a tendency to overdisclose,
self-disclosure in psychotherapy was generally helpful, in part because
it contributed to the formation of a closer bond with the therapist. On
the other hand, according to these authors, encouraging self-disclosure
in the treatment of typically underdisclosing, autonomous elderly de-
pressed patients can cause problems. Their concern seems to be that
self-disclosing will lead these fiercely independent people to conclude
that it is only the therapist who is capable of solving their problems and
that they themselves are helpless.
In summary, there is considerable evidence that relationships in
which self-disclosure plays a role are as beneficial for the elderly as for
the rest of us. Except for a small subgroup identified by Emery and
Lesher, no one has found any negative effects of self-disclosure, despite
the wide range in age, mental health status, and nationalities of the
elderly populations studied, as well as the widely differing research
methodologies used. Even those least enthusiastic about the value of
self-disclosure generally agree that while it may not be of interest or
value to a particular subgroup of the older population, such as Jerrome's
healthy, community-based female British sample, it probably has value
to other groups. When self-disclosure has been found to be of value, the
value has often been considerable. For instance, Lowenthal and Haven
argue for the importance of a confidant in protecting against social
losses, and Murphy's data show that a confiding relationship helps to
protect an elderly person from depression.

Psychotherapy and the Elderly

Before returning to consider the specific issue of the role of self-
disclosure in psychotherapy of the elderly, it seems relevant to examine
briefly some aspects of the literature. Many authors (e.g., Pfeiffer, 1976;
Blum & Tallmer, 1977) have pointed to the small amount of psycho-
therapeutic treatment available to older people, despite their large num-
bers in the population. Pfeiffer notes that the elderly tend to receive
either no psychiatric services at all, or total care in institutions. The
missing aspect is outpatient psychological services, which are much
more used by other segments of the population.
The absence of large numbers of older people in psychotherapy is
often seen at least in part as a legacy from Freud (cited in Blum and
Tallmer), who is well known to have been highly pessimistic about the
Working with Older Adults 181

usefulness of therapy for anyone over age 45. Other factors, both psy-
chological and societal, are clearly involved as well. Tallmer (1982) cited
the glorification of independence in this age group, and the correspond-
ing notion of help-seeking as immature. Today's elderly are also not part
of a birth cohort in which seeing a therapist is easily understood by
peers or family. Pfeiffer (1976) also pointed to the importance of the
misconception that, in the elderly, a degree of depression, emotional
upset, and forgetfulness are to be expecte~, and therefore do not war-
rant treatment. These assumptions would clearly not be made if the
same symptoms were found in a younger person. I can recall a psychi-
atrist arguing that a hospitalized man was suffering, not from a major
depression critically in need of treatment, but from what he labeled "a
masked old-age thing," for which treatment of any type would be
useless.
Societal images of the elderly as entrenched in their ways and un-
able or unwilling to change also contribute to decreasing the likelihood
that an older person will be referred for therapy. Once a referral is made
and treatment is begun, societal pressures also seem to affect the length
and nature of the treatment offered, with a bias toward briefer and less
insight-oriented therapy for older patients. Lakin, Oppenheimer, and
Bremer (1982), for example, speaking specifically of group treatment,
advocated "an acceptant, encouraging, supportive and nonconfronta-
tional mode" (p. 452), including the "mild amplification of feelings," and
strong encouragement of sharing and comparing feelings and experi-
ences. They believe that most elderly people prefer to discuss concrete
issues, and they specifically discourage group leaders from focusing on
intra-individual or interpersonal struggles within the group. It is note-
worthy that, while the desire to focus on concrete issues would be
viewed as a resistance by most therapists working with younger people,
when seen in work with the elderly, it is accepted as a virtually immuta-
ble quality.
Other writers, including some who view themselves as advocates of
psychotherapy for the elderly, also promote supportive rather than in-
sight-oriented treatment strategies. Pfeiffer (1976), for example, dis-
cussed the need for "significant modifications in technique" in working
with older people. Among other changes, he endorses increased activity
in the treatment by the therapist, including "symbolic giving," and
"specific or limited goals" for the work. He views old age as associated
with loss, and saw the therapeutic relationship with an older patient as a
symbolic replacement for these losses. He believes in the value of a long-
term commitment to the patient but emphasized that this does not re-
quire frequent or prolonged contacts between patient and clinician, as-
sumed by Pfeiffer to be a physician. He mentioned, for example,
182 Lisa R. Greenberg

patients whom he felt were "symbolically connected" to him, though he

saw them only twice a year. Of particular interest in terms of the issue of
self-disclosure are Pfeiffer's comments that during his visits with these
patients he showed them pictures of his family, and that he and the
patient "share in each other's growth and accomplishments" (p. 197).
Goodstein's (1982) thoughts on psychotherapy with older people
were similar, though, in contrast to Pfeiffer, he did state that some older
people need primarily insight-oriented work. Others, identified by him
as those with a history of coping well, benefit most from treatment that
is supportive and cognitively oriented. Like Pfeiffer, Goodstein seemed
to emphasize more supportive treatments, and he too encourages the
therapist to make certain changes in technique. He suggested, for ex-
ample, that therapists serve as "total health care coordinators" for their
elderly patients, and he encourages the setting of specific, limited goals
and tasks for the therapy. He also encouraged the use of self-disclosure
by the therapist much as Pfeiffer does, i.e., to build the therapist into the
patient's life as a replacement for losses suffered by the patient. He
identified talking of common interests and feelings as potentially valu-
able in providing a "symbolic but safe implication of intimacy" (p. 414),
and suggested that therapists play cards or checkers or even share an
occasional brandy with their patients.
It is important to note that Goodstein was not suggesting these
techniques be used to forge an empathic connection between patient
and therapist, which would then be the basis for exploring troubling
issues in the patient's life. Likewise, they were not to provide a direct
look at the patient's ways of interacting and viewing the world. Social
activities between patient and therapist were instead to be viewed as an
end in themselves: in Goodstein's words, the therapist is to serve as "a
permanent source of need fulfillment." In other words, the patient is to
accept a substitute for true intimacy; he or she has been determined by
the therapist to be no longer capable of forming true intimate relation-
ships and so is being given a substitute instead.
Certainly, not all authors considering psychotherapy with the el-
derly share a bias toward supportive treatments. Tallmer (1982), for ex-
ample, wrote of analytic treatment with elderly patients. She did feel
that some changes in technique may be necessary, but her suggestions,
such as modifying seating arrangements or lighting to accommodate
hearing- or vision-impaired patients, are to be implemented when ap-
propriate to allow a traditional treatment to occur, rather than to change
the nature of the therapy itself, as suggested by Pfeiffer and Goodstein.
Cohen's (1981) thoughts on psychotherapy with the elderly also
point to the value of insight-oriented treat .nent for older people. In his
view, it is problematic to conceptualize the issues of old age primarily in
Working with Older Adults 183

terms of loss. Instead, he cites those who view old age as a time of
transformation, which involves additions as well as losses, and his view
of therapy includes a belief in the value of helping an older patient to
explore and make use of what has been added. Cohen also cautioned
that, in focusing on the specifics of psychotherapy with the elderly,
there is a risk of neglecting much of what is known about psychotherapy
in general, and is equally applicable to work with all patients, regardless
of age. Related to this is Wylie and Wylie's (1987) contention, in one of
the few case studies to be found of an analysis of an older patient, that
the reluctance of an analyst to begin an analysis with an old patient is a
countertransference resistance.

Self-Disclosure by Therapist
Having briefly summarized the writings of therapists who advocate
supportive treatment for the elderly, and then those whose orientation
is more analytic, it is interesting to observe that the issue of the thera-
pist's self-disclosure arose only in the work of those, i.e., Pfeiffer and
Goodstein, who advocate more supportive treatments. Furthermore, as
alluded to earlier, both Pfeiffer and Goodstein seem to use self-
disclosure to foster and maintain an empathic connection between
patient and therapist, but not to deepen the therapeutic process and
promote insight. The therapist's role is not to assist the patient in deve-
loping attitudes and skills necessary to build a better life, but simply to
satisfy symbolically the patient's needs. This approach seems patroniz-
ing and is based on certain highly questionable assumptions.
Perhaps the primary assumption here is that "the elderly" can
usefully be viewed as a homogeneous population. It is no doubt true
that there are many elderly patients who, because of some combination
of physical disability, psychiatric disturbance, and cognitive impair-
ment, are truly unlikely to be able to form new relationships and to find
many sources of gratification in their lives. For these people, assuming
the therapist can determine who they are, using Pfeiffer's model of the
therapist as a permanent symbolic substitute for lost relationships is
probably valuable. Some support for this treatment strategy can be
found in Murphy's finding, earlier cited, that even relatively infrequent
contacts with a confidant protects against depression.
The danger, however, lies in believing that this treatment approach
is appropriate for all older patients. For most old people, the role of
therapist should be, as it is for patients of all ages, to foster growth and
development, and to help the patient to be able eventually to gratify his
or her needs outside the therapeutic relationship. Support for these
184 Lisa R. Greenberg

goals as realistic can be found from several sources. Murphy (1985), for
example, found her elderly subjects who ranged in age from 65 to 89, to
have a "remarkable capacity" to form new close relationships after their
depressive episodes had passed. Jerrome, too, found that most of her
older subjects were able to increase their circle of friends to the degree
they desired. If, in fact, most older people are able to form new positive,
intimate relationships, at least when they are not depressed, this argues
that the role of a therapist should be to aid older people in the resolution
of their difficulties, and not to supply them directly with intimate rela-
tionships. Perhaps it is most significant that clinical researchers have
not found a relationship between patient's age and therapy outcome
(Blum & Tallmer, 1977), indicating that major therapeutic modifications
may not be necessary for successful psychotherapy with the elderly.
This leads us to the question of whether self-disclosure by the thera-
pist has a role in insight-oriented treatment with the elderly. It seems to
me that, as with patients of other ages, self-disclosure by a therapist
working with an elderly patient mayor may not be helpful, mayor may
not be countertransferential, and mayor may not advance the process.
The factor that determines whether a particular self-disclosure by the
therapist is helpful seems to me to be largely independent of the pa-
tient's age.
Several incidents come to mind. One was of unintended by unavoid-
able self-disclosure, which had positive consequences. Some years ago,
I broke my foot and arrived at work in an inpatient psychogeriatric
setting with a cast up to my knee. To my surprise, a very depressed and
withdrawn man, after laughing (somewhat sadistically, it seemed to
me) at my feeble attempts to walk, was able to consider my ability to
continue to work and apparent good spirits. Previously, I had been seen
as young, healthy, and problem-free, and therefore, as unable to com-
prehend his pain and inability to function. My cast, however, impelled
him to ask some version of the question, "If you have that and are still
OK, why aren't I managing despite my problems?" He began to shift
from accepting his paralyzing depressions as inevitable to questioning
his own investment in not functioning.
Similarly, when I became engaged to marry, one of my patients in
both group and individual therapy was a psychotic woman in her early
70s, who had always been single. When I told her of my plans to marry,
she reacted with a bizarre tirade comprising attacks both on me for my
presumed abandonment of her and, even more vehemently, on herself
for having failed ever to marry. With the help of me and my coleader
and, perhaps most particularly of her elderly fellow group members,
however, she was able to work through some of these feelings. She came
away with at least a limited sense that there were many possible ways of
Working with Older Adults 185

living, and that it was by no means essential to have been married to feel
that one's life has been of value.
This anecdote also points to a relation between the value of self-
disclosure by the therapist and the age of the patient. Self-disclosure by
a young therapist, often of something important in his or her present
life, can at times serve to promote the patient's process of life review, as
described by Lewis and Butler and previously discussed. Any mention
at all of such events as marriage or pregnancy, for example, often trig-
gers a flood of memories of the patient's own experiences of these major
life events, and thereby provide an opportunity to work on any unre-
solved issues.
There is, however, also a caveat regarding a young therapist's self-
disclosures to an older patient. Therapists at times attempt to use self-
disclosure to communicate to patients that they understand and can
empathize with the patient's experience, when, in fact, their own life
may have been so different that their capacity for understanding and
empathy is not as great as they would like. Today's elderly have had life
experiences that differ dramatically from those of their therapists, par-
ticularly if their therapists are much younger. Often, therapy is occur-
ring between one person who has directly experienced immigration, the
Great Depression, and one, if not two, world wars. Setting aside issues
that are purely personaC these differences alone are important. Rather
than forcing an unreal connection by expressing too much empathy too
quickly, or sharing a life experience that is only mildly similar to that of
the patient, it is often more helpful for a young therapist to listen with
attention and respect, and to be open to being educated. My sense is
that comments that are intended by the therapist to build a connection
with the patient by pointing to similarities between them are often
instead felt as disappointing intrusions by the patients in that they re-
mind the patient that there is, after alC a wide gap between them.
This leaves open the question of what self-disclosing statements by
the therapist do and do not tend to be helpful. Perhaps most helpful are
those remarks that the therapist freely makes about his or her own life,
with no expectation of any particular response, while those that almost
urge the patient to experience a connection that mayor may not be real
can be instead distancing and hurtful.

Self-Disclosure by Older Patients

Having discussed the issue of self-disclosure by the therapist in the
treatment of elderly patients, the obvious remaining subject is self-
disclosure by patients themselves. Lakin et al. (1982) report a relevant
186 Lisa R. Greenberg

study designed to compare group behaviors of older (age 65 +) and

younger (college students) subjects in unstructured helping groups led
by the authors. Self-disclosure was found to be significantly higher for
all the older adult groups than for the younger groups, and also to differ
in quality between the age groups. Older people talked easily about
major problems, including loneliness and fear of abandonment, but the
authors report an "almost stereotypic quality" in both the disclosures
and the empathic responses they elicited. The authors contrast this to
the behavior of the younger subjects, who, while generally more defen-
sive and less disclosing, spoke with more affect when they did disclose.
Discussions among the old were reported to be "less jagged"; the au-
thors surmise that this is because these subjects have a firmer sense of
their own identity and a related sense of confidence that others will feel
as they do. The young, on the other hand, tend to feel alone in their
feelings, making self-disclosure feel much riskier to them.
In some ways, my own experience has been consistent with the
findings of Lakin et al. In conducting interviews for the research dis-
cussed above (Greenberg, 1982), for example, I too observed a willing-
ness to self-disclose. In fact, subjects often seemed to welcome having
an opportunity to talk about many aspects of their lives with an inter-
ested younger person. There was, however, in almost all cases, a clear
reluctance to disclose any painful affect and, in particular, to acknowl-
edge situations that caused feelings of shame or guilt.
This pattern of talking freely and easily in response to direct ques-
tions about one's life, but becoming reserved in discussing painful feel-
ings, seems to occur frequently in clinical settings as well, and seems to
me to have several bases.
One issue that comes into play concerns the ways in which today's
generation of older people were socialized. For most people, fulfilling
one's obligations to others was valued far above one's own feelings. As a
woman in her 70s said to me regarding her view of being a housewife
while in her 20s, "You didn't know from anything, how could you be
unhappy? Like a caveman, he was happy in his cave, everybody be-
lieved the same." Clearly, she had been taught to minimize the impor-
tance of her own needs and feelings. This value system is in marked
contrast with that of psychotherapy, in which the focus is on one's self
and one's feelings. This contrast in values can be confusing and alarm-
ing for an older person encountering a therapist for the first time. My
impression is that the elderly patient is often mystified by the therapist's
inquiries, and is left wondering, "What does this person want from me?"
Many older people also walk into a therapist's office expecting an
experience similar to that of seeing a medical doctor, and this too can
Working with Older Adults 187

present a barrier to self-disclosure. Instead of understanding therapy to

be a collaborative process, the therapist is perceived as a "doctor" who
administers a cure with little input from the patient. (My own grand-
mother refused for years to answer questions put to her by any clinician,
claiming that if they were supposed to know so much, why did she have
to tell them?)
Another factor leading many older people to refrain from speaking
freely about themselves seems to be a fear of damaging the status quo. It
is as if they are afraid of undertaking Lewis and Butler's (1974) life
review, as if they might be unable to come to terms with their own
choices, and therefore prefer to leave well enough alone. Here, what
appears to be a reluctance to speak freely to another is actually a desire
to avoid acknowledging certain realities to one's self. As a woman, filling
out a form requiring her to choose between "painful" and "pleasurable"
to describe herself, said to me, "Well, it would be a shame to say 'pain-
ful,' so I'll say' pleasurable'." It seemed clear that she was afraid to look
too closely.
A related barrier to self-disclosure among old people is their fear of
being judged negatively for any feelings or behavior that violate their
idealized image of themselves, which is often society's image as well.
That is, they are to be nonaggressive, nonsexual, noncompetitive and, at
least for women, nurturing of others. Acknowledging that this is not
always the case may be particularly difficult when the therapist is much
younger than the patient, and is transferentially experienced as the
patient's child, in whose eyes one must be a mature adult. Counter-
transferentially, as well, there may be difficulty in accepting that a par-
ental figure may not live up to the therapist's infantile expectations.
Having identified all these factors that at times contribute to making
self-disclosure in therapy difficult for old patients, I must also say that
these factors are in no way to be viewed as contra indications for psycho-
therapy for older patients, or as reasons to promote particularly directive
forms of treatment. Rather, they can be seen as resistances to be worked
on in therapy.
In addition, I also believe that there is a subgroup of older patients
who, while they may experience some of these conflicts, put them aside
extremely quickly and self-disclose easily, effectively, and with impres-
sive results. The woman whose case introduced this chapter is among
those for whom self-disclosure has always been actively discouraged,
and yet who are so desperate to share their experiences that an oppor-
tunity to do so is eagerly seized. Patients like this are less resistant than
the norm, and often benefit tremendously from short-term dynamic
treatment.
188 Lisa R. Greenberg

Summary
This chapter has considered the issue of self-disclosure and the
elderly from several perspectives. Most of the literature on the value of
self-disclosing relationships for the elderly concludes that for the elderly,
as for people of other ages, confiding relationships are of value, particu-
larly in maintaining morale during periods of loss. This is a powerful
argument in favor of psychotherapy, a particularly intense and valuable
self-disclosing relationship, for older people. It is thus particularly un-
fortunate that old people tend to be underrepresented as therapy pa-
tients, and that the therapy that is done with this population tends often
to be more directive and supportive than is the case with younger pa-
tients. While most investigators only consider the role of the therapist'S
self-disclosure in therapy with the elderly in discussions of supportive
treatments, self-disclosure by the therapist can facilitate an insight-
oriented treatment as well. For example, the therapist's self-disclosure
can provide an opportunity for the patients to rework significant events
in their own lives.
Barriers to self-disclosure by elderly patients are often observed.
These include issues arising from the ways in which these patients were
socialized, and others based on transference-countertransference dy-
namics. These barriers are minimal for many patients but, even for
those for whom they are considerable, they are not obstacles that make
therapy impossible, but therapeutic challenges that must be worked
through as part of the valuable and gratifying work of treating older
people in psychotherapy.

References
Andersson, 1. (1985). Intervention against loneliness in a group of elderly women: An
impact evaluation. Social Science and Medicine, 20 (4), 355-364.
Blum, J., & Tallmer, M. (1977). The therapist vis-a.-vis the older patient. Psychotherapy:
Theory, Research and Practice, 14 (4), 361-367.
Cohen, G.D. (1981). Perspectives on psychotherapy with the elderly. American Journal of
Psychiatry, 138 (3), 347-350.
Emery, G., & Lesher, E. (1982). Treatment of depression in older adults: Personality consid-
erations. Psychotherapy: Theory, Research and Practice, 19 (4), 500-505.
Goodstein, R.K. (1982). Individual psychotherapy and the elderly. Psychotherapy: Theory,
Research and Practice, 19 (4), 412--418.
Greenberg, 1.R. (1982). Subjective experiences of elderly women as a function of employ-
ment history and experience of the past. Doctoral dissertation, Adelphi University.
Dissertation Abstracts International, 43 (03-B), 870-1054. (University Microfilms No.
AAD82-1900l).
Hatfield, E. (1982). Passionate love, compassionate love, and intimacy. In M. Fisher and G.
Stricker (Eds.), Intimacy. New York: Plenum.
Working with Older Adults 189

Jerrome, D. (1981). The significance of friendship for women in later life. Aging Society, 1,
175-197.
Lakin, M., Oppenheimer, B., & Bremer, J. (1982). A note on old and young in helping
groups. Psychotherapy: Theory, Research and Practice, 19 (4), 444-452.
Lewis, M.l., & Butler, R.N. (1974). Life-review therapy. Geriatrics, 29, 165-173.
Lowenthal, M.E, & Haven, C. (1968). Interaction and adaptation: Intimacy as a critical
variable. In B. Neugarten (Ed.), Middle age and aging. Chicago: University of Chicago
Press.
McMahon, A. w., & Rhudick, P.J. (1964). Reminiscing: Adaptational significance in the
aged. Archives of General Psychiatry, 10, 292-298.
Murphy E. (1982). Social origins of depression in old age. British Journal of Psychiatry, 141,
135-142.
Murphy, E. (1985). The impact of depression in old age on dose social relationships.
American Journal of Psychiatry, 142 (3), 323-327.
Pfeiffer, E. (1976). Psychotherapy with elderly patients. In L. Bellak & T. Karasu (Eds.),
Geriatric Psychiatry. New York: Grune & Stratton.
Tallmer, M. (1982). Intimacy issues and the older patient. In M. Fisher & G. Stricker (Eds.),
Intimacy. New York: Plenum.
Wylie, H.W., & Wylie, M.L. (1987). The older analysand: Countertransference issues in
psychoanalysis. International Journal of Psychoanalysis, 68 (3), 343-352.
 13
Self-Disclosure in Group
Psychotherapy
Sophia Vinogradov and Irvin D. Yalom

John, usually a silent member, opened a group meeting with a carefully

planned statement about an episode of sexual abuse he had experienced as a
child. He told the story in a deliberate manner with a flat expression. When
he finished, there were a couple of minutes of silence, whereupon John said,
half-jokingly, that he didn't give a damn if the group responded to him or
not. Soon the disclosure evoked many reactions in the rest of the group.
Another member, Steven, began to weep, recalling a past experience of sex-
ual molestation and its subsequent influence on his sexual identity. Two other
members offered him some words of support, which fell on deaf ears; this
permitted the leaders to point out how hard it is for Steven to accept comfort
from others. One member commented that she felt confused by the discrep-
ancy between how much John revealed and his flat, rehearsed manner of
revelation. Another member, Mary, had an entirely different set of responses
to John: she felt that his overwhelming self-disclosure put pressure on other
group members to respond in kind. She resented this pressure and felt ma-
nipulated by John. A lively and engaging session ensued, with many com-
plex variations on the theme of self-disclosure.

Every group psychotherapist knows that, if a therapy group is to

function optimally, members must disclose a great deal of personal
material to one another. And yet, self-disclosure is important in individ-
ual psychotherapy as well. What distinguishes the two? What is unique
about self-disclosure in the context of a group?

Sophia Vinogradov • Department of Psychiatry, Pacific Presbyterian Medical Center,

San Francisco, California 94115. Irvin D. Yalom • Department of Psychiatry and
Behavioral Sciences, Stanford University School of Medicine, Stanford, California 94305.

191
192 Sophia Vinogradov and Irvin D. Yalom

There are several answers to these questions. First of all, we may

dichotomize disclosure into two forms: vertical self-disclosure, where one
reveals material about one's past, or about one's outside life, and horizon-
tal self-disclosure, where one examines the interpersonal effects and im-
plications of revealing oneself. In the example above, John engaged in
vertical self-disclosure and was joined in this by Steven, who shared
early memories that had been evoked by John's disclosure. In this clini-
cal situation, the leader deliberately refrained from reinforcing the verti-
cal disclosure either by exploring it or by encouraging more vertical
disclosure from John, Steven, or the other members. Instead, the leader
encouraged the process of horizontal disclosure - by encouraging John
to examine how he felt about sharing this material, by asking whose
opinion was particularly important to him and how he felt about the
support offered him (both the explicit support of other members and the
implicit support of Steven, who, by revealing similar painful material,
had given John a gift). The leader also encouraged a discussion of Mary's
observations about John's style of delivery, and her feelings of having
been coerced and manipulated. The examination of these aspects of
horizontal disclosure was enlivening to the group and far more produc-
tive for them than the other clinical option of delving more deeply into
the content of John's early sexual abuse.
Second, in group therapy, patient self-disclosure is greatly influ-
enced by the attitude and role of the group leader, who is generally more
self-disclosing than the individual therapist. The leader who judiciously
uses his or her own person to relate authentically to others in the group
creates an atmosphere in which sharing, mutual respect, and interper-
sonal honesty are modeled. Consider this vignette:
In the tenth meeting of a sixteen session therapy group, one of the therapists,
Irv, was called out of town because of his mother's death. Joan, his co-
therapist, not wanting to intrude on Irv's privacy, explained his unexpected
absence by vaguely referring only to a death in the family. When Irv returned
to the group the following week, members acted curious, but were very
uncomfortable when asking questions about his absence. At this point, Irv
revealed to the group that he had been out of town because his mother had
died, and he encouraged members to ask questions and to explore the rules
of what they could and could not ask a therapist. Members had many strong
and sympathetic reactions, and asked a series of appropriate questions: How
was Irv doing? Would he like to use the group to work himself? How did he
get help in times of distress? What was his relationship to his mother? Irv
answered all questions openly and honestly, at times giving the members
more information than they requested. The group seemed satisfied and
turned to continue productive work on other issues.

In this example, the therapist's disclosure liberated the group; the

members were persuaded that the therapist was coping well and that he
had the energy available to work with them. Furthermore, the therapist's
Self-Disclosure in Group Psychotherapy 193

self-disclosure served as good modeling and encouraged the patients, in

turn, to reveal more of themselves and to relate more honestly to others.
From the patient's point of view, self-disclosure occurring in the
context of a group carries a higher risk than that occurring in a patient-
therapist dyad. There is more chance of being misunderstood or re-
jected by a group of individuals who are, after all, fellow patients, and
not paid to be supportive. In like manner, however, self-disclosure in
group therapy has a higher return: Genuine acceptance by fellow group
members carries a great deal of meaning and weight.
From the therapist's point of view, self-disclosure in group therapy
plays a very different role than it does in individual work. Initially, it
serves to increase group cohesiveness and it contributes to members'
sense of sharing and belonging. It allows therapists to identify members
who show deviant participation in the group, either those who reveal too
little, or those who reveal too much too soon. And finally, self-dis-
closure, especially horizonal self-disclosure, is absolutely essential to
the development of interpersonal learning in the group.
As our clinical vignettes illustrate, the process of self-disclosure
and of developing closer, more genuine relationships within the context
of the psychotherapy group is complex, and quite different from the
process of self-disclosure in individual psychotherapy. Both patient and
therapist play an important role in its development.

Patient Self-Disclosure in Group Psychotherapy

Self-disclosure, whether it takes place in group therapy or in indi-

vidual therapy, takes many forms: Patients may reveal material involv-
ing past or current experiences, personal fears, fantasies or dreams, and
hopes, aspirations, and concerns for the future. However, there is in
group therapy an additional dimension of self-disclosure: Patients in a
group setting may also reveal and explore their feelings towards the
other members and interactions in the room, often referred to as here-
and-now disclosure. This process plunges members into the "here-
and-now" of the group's interactions and forms an integral step in the
process of learning about one's interpersonal relationships (see Yalom,
1985). Here-and-now disclosure occurs ih individual therapy as well,
particularly when the patient expresses his or her feelings about the
therapist as they arise during a session; however, it is more limited and
unidirectional in nature, as the patient rarely receives similar feedback
in return from the psychotherapist.
194 Sophia Vinogradov and Irvin D. Yalom

The Importance of Patient Self-Disclosure

in Group Psychotherapy
If the timing and atmosphere are right, nothing commits individual
members to a group more than to receive (or to reveal) some previously
secret material. The entire group feels privileged when a member is able
to disclose for the first time something that has been burdensome for
years; the individual feels exhilarated as he or she is understood and
fully accepted by the group. With gradually increasing levels of self-
disclosure, the entire membership of a group strengthens its involve-
ment, responsibility, and obligation to one another.
A large body of research evidence underscores the importance of
self-disclosure in group therapy. First, high levels of disclosure in a
group have been demonstrated to increase group cohesiveness (Bloch,
1981; Query, 1964; Johnson, 1974). People are apt to reveal more to those
they like, and group members who reveal themselves are in turn more
liked by others (Worthy, 1969). Patients who disclose early in the life of a
group are often very popular, and the popularity of a patient in a ther-
apy group correlates positively with therapy outcome (Yalom, 1967). As
a general rule, patients who are ultimately successful in group therapy
make more self-disclosing statements (Peres, 1947; Truax, 1965; Lieber-
man, 1973).
Some investigators consider self-disclosure to be so central to the
healing or curative process of a group psychotherapy that they identify it
as a therapeutic factor per se (Bloch, 1980). Certainly, interpersonal theo-
rists such as Sullivan and Rogers have maintained that self-acceptance
must be preceded by acceptance by others; in order to accept oneself,
then, one must allow others to know and accept one as one really is.
Yalom has expanded this point by noting that-although self-dis-
closure is indeed intrinsically valuable-its real usefulness in group
therapy occurs within the matrix of interpersonal learning (Yalom,
1985). Patients fhi.d self-disclosure to be an important act not only be-
cause of the sheer relief they feel from ventilating a secret, but because
they can then go on to experience the interpersonal response from
others to their disclosure. To reveal oneself, and then to be actively
accepted and supported by others, is deeply validating. Patients often
entertain some disastrous or shameful fantasy about revealing less-
than-ideal parts of themselves; to allow others to see "the real me" and
to have that fantasy disconfirmed is highly therapeutic.
Not only are patients rewarded by other group members for their
disclosure, but they learn more about why it was difficult to reveal parts
of themselves and about how this affects their relationships both in the
group and in real life. Ultimately, this insight and this behavior change
Self-Disclosure in Group Psychotherapy 195

in the group-this interpersonal learning-is transferred into the pa-

tient's real life relationships.

The Process of Patient Self-Disclosure

Self-disclosure is a complex social and psychological act which is

bound by one's role and one's situation. Time, place, and person all enter
into the balance of what determines appropriate acts of self-disclosure.
A challenging and helpful exchange between two senior members in an
advanced interactionally oriented therapy group (e.g., "I finally feel able
to tell you how arrogant I find you") may be threatening to neophytes in
a less-advanced group, and may be downright destructive in an acute
inpatient group of decompensated patients.
No matter what the timing or context, self-disclosure in the group
must be guided as much by a sense of responsibility and empathy for
others as by total openness and honesty. Hostile and destructive interac-
tions can occur in groups under the guise of self-expression: "Okay, so I
made a hurtful comment to Mark. But you told us that we should be
perfectly honest about our real feelings!" The group therapist will find
that, for some people, disclosure about overt angry or hostile feelings
comes easily. The therapist will need to encourage such individuals to
self-disclose at a deeper level, and to reveal the feelings that underlie
and account for their anger or hostility-feelings that might include
fear, envy, or sadistic pleasure.
The group therapist may also need to remind members that, if self-
disclosure is to promote greater sharing and closeness, it must occur in a
context of remaining constructive and responsible to others. Full self-
disclosure is never possible; there will always be layers of reactions that
we choose not to share with others: secret judgments about physical
traits, impatience with intellectual mediocrity, stereotypes about social
class, boredom, fleeting sadistic or sexual fantasies, and the like. We
refrain from revealing these sorts of feelings because of more overriding
concerns of empathy and responsibility. The therapist may, in fact, wish
to emphasize that for many individuals high-risk disclosure consists
not of making negative remarks to others, but of taking the chance to
honestly and openly voice positive feelings in the group, feelings such
as admiration, concern, attraction, and closeness.

Problems in Maladaptive Patient Self-Disclosure

Too little self-disclosure can prevail when the entire group is blocked
and unable to share any personal material. There are many causes for
this situation: distrust of the group leader, fear that the group may not be
196 Sophia Vinogradov and Irvin D. Yalom

safe (usually because of the presence of a hostile or agitated member),

concern about judgmentalism in the group (such as when some mem-
bers seem extremely judgmental about marital fidelity). Occasionally
there is concern about confidentiality; when members lack trust in the
confidentiality of group material, they are reluctant to discuss personal
issues. For example, a therapy group led on a university outpatient
service was being videotaped for teaching purposes; because members
felt threatened in their anonymity and privacy by the videotaping, the
group remained very superficial and blocked in its interactions.
A therapy group as a whole can also fail to develop appropriate
levels of self-disclosure when it lacks one or more members who are able
spontaneously to reveal personal material and serve as pace-setters.
This problem is generally amenable to appropriate modeling by the
leader, who can demonstrate or encourage self-disclosing statements
and foster a more revealing, more interactional kind of group.
Even in a group where most members are disclosing appropriate
amounts of personal material, there may be individuals who are unable
to reveal very much to others. Often a member will disclose little about
him- or herself because of a sense of shame and fear of nonacceptance.
And yet, without honest self-disclosure, the group is unable to relate to
that member or to accept him or her in any kind of authentic way;
without genuine acceptance by others, the individual has little hope of
self-acceptance and little chance for experiencing a rise in self-esteem.
As a general rule, too little self-disclosure by an individual member
reduces his or her chances for forming meaningful relationships in the
group.
Some individuals dread self-disclosure not because of shame or fear
of nonacceptance, but because they are heavily conflicted in the area of
control: to them, self-disclosure is dangerous because it makes them
vulnerable to the control of others. When others in the group have made
themselves exceedingly vulnerable through self-disclosure, then, and
only then, is such a person willing to reciprocate.
Phillip, a member of a 20-session outpatient group, had gone
through two unsuccessful marriages and was extremely distrustful of
women. He kept prodding the women members in his group to lay their
inner selves bare before he would reveal anything; this posture soon
made the women members feel exploited and angry, creating a self-
fulfilling prophecy in Phillip's relationships with women in the group.
In some group settings, particularly those involving professionals
(such as a T-group for psychology interns, or a staff retreat for leu
nurses), honest self-disclosure is discouraged by a climate of competi-
tion or judgmentalism. In addition, if one reveals personal vulnerabilities
or character flaws, one may be open to criticism about professional
Self-Disclosure in Group Psychotherapy 197

performance. In mental health fields in particular, one's professional

competence is seen as overlapping heavily with one's emotional matu-
rity-self-disclosure thus represents a double jeopardy, as it opens the
individual to judgments about both personal health and professional
competence.
In specialized groups oriented towards support (such as an eating
disorders group), where members place a premium on being "nice" or
"polite," self-disclosure often becomes equated with "taking up time for
oneself" and not being supportive and concerned about others. In these
cases, patients have made the mistaken assumption that self-disclosure
consists solely of recitation, rather than a reciprocal, dynamicallyevolv-
ing process among all group members.
Some group members are so concerned about maintaining a so-
cially attractive facade that they dwell on appearances: If they open up
about their problems, will they appear to be friendless, lonely, pitiable?
Others believe that they do not deserve the time and attention, that what
they have to say about themselves is unimportant, and they therefore
reveal things in an apologetic, hesitant, telegraphic manner. Other indi-
viduals, and these may be the majority of new group members, simply
don't know how to self-disclose in an appropriate way.
Too much self-disclosure can be as maladaptive as too little. Some
patients reason that if self-disclosure is desirable, then continuous and
total self-disclosure must be even better. They fail to realize that it is not
the amount of self-disclosure on an absolute scale, but its occurrence in
the context of the relationship between discloser and receiver, that de-
fines a healthy pattern of self-disclosure. Under normal circumstances,
individuals disclose different types and amounts of material, depending
on whether the receiver is a family member, a work associate, or a best
friend (Jourard, 1950).
Some maladaptive disclosers disregard the nature of their relation-
ships to the people they talk with, and indiscriminately "spill their guts"
to any and all who fall within earshot. In group psychotherapy, the
individual who reveals intimate material before knowing the group well,
or who lets it be known that this same material has also been shared
with mere acquaintances outside the group, perplexes the other mem-
bers. First, a great deal of self-disclosure can frighten off unprepared
recipients: What are the implications of this much sharing? What will
the discloser want in return? Is this an implied demand that they must
reciprocate in turn? Second, the group may feel devalued, even de-
ceived, when it learns that supposedly intimate material confided by
one of its members has in fact been related on numerous occasions to
others outside the group.
Members who reveal early and promiscuously will generally drop
198 Sophia Vinogradov and Irvin D. Yalom

out early in the course of group therapy (Yalom, 1966, 1985). Although
patients should be encouraged to take risks in the group, to reveal them-
selves, and to obtain feedback and reinforcement for their behavior, they
may -if they reveal too much too soon - exceed their own tolerance and
that of the rest of the group. The member who has self-disclosed too
early may feel so much shame in the group that the interpersonal re-
wards seem insignificant or unsatisfactory. Furthermore, such individ-
uals may threaten other members who are willing to be accepting and
supportive, but who are not yet prepared to reciprocate with an equiva-
lent degree of self-disclosure. Consequently, they refuse to "join" with
the discloser, who may be placed in such a vulnerable and isolated
position that he or she often chooses to flee.

Evelyn was a faithful but largely silent member of a newly formed support
group for women engineering students. As the group began to become more
interactive, other members started turning to Evelyn and attempting to draw
her out. She steadfastly resisted these attempts, frustrating the group and
perplexing the leaders.
At the fourth meeting, during a rather general discussion on the subject
of intimacy, Evelyn suddenly revealed that she was having an extramarital
affair with her advisor, and that this was turning into an exploitative and
abusive relationship. The other group members, although sympathetic, were
stunned by this dramatic and unexpected revelation from a usually silent
and resistant individual.
During ensuing sessions, members found they were having a great deal
of difficulty offering Evelyn helpful feedback. In addition, all further at-
tempts at eliciting more material from her were useless; Evelyn "clammed
up" again and refused to share anything more with the group. Three weeks
later, she dropped out of the group without any forewarning.

Therapist Self-Disclosure in Group Psychotherapy

Group psychotherapists may-just like other members in the

group-openly share their thoughts and feelings in a judicious and
responsible manner, respond to others authentically, and acknowledge
or refute motives and feelings attributed to them. In other words, thera-
pists, too, can reveal their feelings, the reasons for some of their behav-
ior, acknowledge the blind spots, and demonstrate respect for the
feedback group members offer them.
This form of therapist self-disclosure, or therapist transparency, has
two effects in the group: First, it counteracts the effect of transference,
or irrational responses to the group leader. In the face of ever-increasing
reality-based data revealed by the therapist, members find it more and
Self-Disclosure in Group Psychotherapy 199

more difficult to maintain their fictitious beliefs about the group leader.
By gradually revealing more of him or herself, by reacting to the patient
as a real person in the here and now, the therapist helps members to
confirm (or disconfirm) attitudes and abilities attributed to him or her
on the basis of unconscious fantasies. Second, the judicious use of thera-
pist transparency models interpersonal sharing and honesty for the rest
of the group. In this manner the therapist can reinforce norms of self-
expression and self-exploration, while modeling responsibility and
restraint.

Two Forms of Therapist Transparency

A group leader noticed that, once again, Barbara, an unusually shy member,
had not spoken at all during the session. She had sat quietly with a pained
expression on her face, and now, towards the middle of the meeting, she was
glancing frequently at her watch. "You know; Barbara," the leader said. "I've
noticed you looking at your watch as if you're wondering when the meeting
will be over. I sense some pain in you and I'd like to bring you into the group
today-one of my roles is to help all members participate. Yet I feel caught in
a dilemma; I feel paternal towards you, like I want to rescue you, but I often
do too much of that and it feels like I'd just be infantilizing you. Also, there's
a part of me that doesn't want the obligation of being your rescuer."

There are two aspects to therapist self-disclosure or transparency:

personal, and professional. In personal self-disclosure, the therapist
behaves and reacts in the real time of the group. He or she carefully
chooses to reveal personal thoughts or feelings that are germane to
ongoing interactions and that might facilitate the group process ("1 don't
want the obligation of being your rescuer," or "1 feel paternal towards
you"). This consists of providing (and accepting) honest, constructive
feedback; of stimulating interpersonal learning by sharing reactions in
the group; and of modeling nonjudgmental acceptance.
When therapists engage in professional transparency, they judi-
ciously reveal the process guiding some of their therapeutic interventions
and the results they feel they have obtained from those interventions.
The professional transparent therapist allows patients to observe the
manner in which the therapist's questions, thoughts, and conclusions
are derived from the data at hand. This can occur when the leader makes
comments during an actual session: "1 feel caught in a dilemma, Bar-
bara ... If I call on you, I infantilize you. If I don't, I have concerns that
you will get little from the therapy, or maybe that you will drop out of the
group."
There are other useful techniques of professional transparency that
are unique to group psychotherapy. Yalom (1985) suggests that the
200 Sophia Vinogradov and Irvin D. Yalom

therapist write a brief synopsis after each session and mail it to group
members, who can read the summary before the next session. Thera-
pists can use this format not only to comment on events in the group, but
to explain why they made the interventions they did, or how they
reached certain conclusions.
Another technique allows group members to watch post-group ses-
sions where the therapist, co-therapist, and any observers describe in
detail their interpretations of the group and their reasons for arriving at
those conclusions. Some rehash sessions even allow for a brief feedback
period from group members (see Yalom, 1983).

Objections to Therapist Transparency

The primary sweeping objection to therapist transparency is based

on the traditional analytic belief that the paramount therapeutic factor in
psychotherapy is the resolution of patient-therapist transference. Ac-
cording to this model, the development of patient-therapist trans-
ference should be encouraged, and the group therapist should aid this
by deliberately remaining opaque. In group therapy, however, other
therapeutic factors are of equal or greater importance; some of these
include altruism, vicarious learning, and cohesiveness. The therapist
who judiciously uses his or her own person in the real time of the group
greatly increases the therapeutic power of the group by encouraging the
development of these other factors (see Yalom, 1985).
In modeling interpersonal transparency, the therapist can directly
attend to here-and-now interactions occurring in the group, and can also
help members examine some of the group process. In the clinical vi-
gnette where the therapist disclosed his mother's death to the group,
this example of therapist transparency stimulated many important in-
teractions and questions among members. Why had they found it so
difficult to ask the leader about his absence? Now that he had told them
about his mother, could they ask more about the nature of his relation-
ship with her? Did they even have the right to ask the therapist if he
would like to talk more about his mother? These issues in turn prodded
several members into discussing their own relationships with their
aging parents, while other members were led to examine some of their
assumptions about what they can and cannot ask the group leader. By
modeling, by showing respect for the process and for the group mem-
bers, by demonstrating that he, too, believes it helps to talk, by letting
members know that he was really all right and could work with them,
the therapist was able to hasten the development of group cohesiveness
and autonomy.
Self-Disclosure in Group Psychotherapy 201

One objection therapists sometimes raise to self-disclosure is the

fear of escalation, the fear that once they reveal themselves, the insatia-
ble group will demand even more. But strong forces in the group oppose
this trend; though members are enormously curious about their group
leader, they also wish the therapist to remain unknown and all-power-
ful. When Joan, Irv's co-therapist, was asked why she had been so
reluctant to give any details about his sudden absence, she revealed to
the group that she had found herself in a dilemma; on the one hand, she
had wanted to be completely open and honest with the group, while on
the other hand, she had wanted to protect Irv's privacy. Rather than
question her any further about her decision to protect Irv at the expense
of the group, members were sensitive to the awkwardness she was
describing and did not press her further. While group members will
generally appreciate the responsible and growth-promoting use of inter-
personal feedback from their leader, few will want therapists to discuss
their own personal problems or professional insecurities (Cohen & Dies,
1976).

Guidelines to the Use of Therapist Transparency

There are many different approaches to therapist transparency, de-

pending upon the therapist's personal style and goals in the group at a
particular time. An important guideline can be obtained by asking one-
self what the purpose of self-disclosure is at any given point in the
group: '~m I trying to facilitate transference resolution? Am I model-
setting in an effort to create therapeutic norms? Am I attempting to
assist the interpersonal learning of members by working on their rela-
tionship with me? Am I attempting to support and demonstrate my
acceptance of members by saying in effect: 'I value and respect you and
demonstrate this by giving of myself'?" At all times, the therapist must
consider whether transparency is consonant with other group therapy
tasks.
Although therapist self-disclosure generally facilitates the group
interaction, it is important to keep in mind that the group therapist's
raison d' etre is not primarily to be honest or fully disclosing. If the
group does not require any therapist transparency, the leader should not
make special attempts to provide it-and certainly, no therapist should
try to bootleg therapy for him- or herself from the group.
Furthermore, leader self-revelation must be guided by the different
needs of the group members. Not all patients need the same thing from
the therapist (or from the group). Some patients need to relax controls,
need to learn how to express their emotions in an honest and respon-
202 Sophia Vinogradov and Irvin D. Yalom

sible manner, whether they be emotions of anger, love, tenderness, envy,

or frustration. They will learn the most from a leader who models spon-
taneous, sharing, affective interactions. Others need quite the opposite:
They need to gain impulse control and learn to accept limits to the
expression of their emotions; they may already be characterized by la-
bile and immediately acted-upon affect. Such patients can learn from a
therapist who shares his or her reactions to their impulsivity, and who
shows them alternative ways of dealing with strong emotions. Finally,
even the transparent and authentically self-disclosing therapist must
provide some cognitive structuring, some intellectual integration to the
group experience. Only in this manner can patients learn to generalize
their group experiences to outside life.

Accepting Feedback as Part of Therapist Transparency

Therapist disclosures will be part of the here-and-now interactions

of the group in that each disclosure reveals something of the inner world
experienced by the therapist in the group setting. Feedback to the thera-
pist about these disclosures will also be part of this cycle of interaction
and reaction, and thus another form of self-disclosure occurs when the
therapist receives and accepts accurate feedback from group members.
There are several general principles that are useful to the therapist when
he or she is receiving feedback from the group.
First, the therapist should take the feedback seriously by listening
to it, considering it, and responding to it directly. The therapist should
then obtain consensual validation: How do other members feel? Is the
feedback primarily a transference reaction, or does it closely correspond
to reality as confirmed by the majority of the group members? If it is
reality-based, the therapist must confirm this in order to facilitate the
patients' reality testing. When Barbara, the silent, pained patient ac-
cused her group leader of not making enough attempts to draw her into
the group, the therapist responded: "Yes, there is some truth in what you
say. I did know you wanted me to call on you today and I deliberately
refrained from doing so. I've been drawing you into the group every
week and it's beginning to feel burdensome to me. I feel I've got to resist
my tendencies to take care of you so that you will begin to take more care
of yourself."
Finally, the therapist should measure the feedback against his or her
own internal experience: Does the feedback fit? Is there something im-
portant to learn from it? The leader who consistently finds herself being
told by members that she comes across as distant and uncaring may find
that this indeed reflects her inner state, and that, for the sake of her
Self-Disclosure in Group Psychotherapy 203

future professional development, she must understand these feelings

and their impact on patients.
The leader's role will undergo a gradual metamorphosis during the
life of any relatively stable interactional group. In the beginning, thera-
pists will busy themselves with the many functions necessary to the
creation of the group, with the development of a social system in which
the many therapeutic factors may operate, and with the activation and
illumination of the here-and-now. Gradually, however, the leader will
begin to interact more personally with each of the members, and the
early stereotypes the patients cast him or her into will become more
difficult to maintain.

Concluding Remarks
Self-disclosure in group psychotherapy is an absolutely integral
part of the therapeutic process, and carries risks and gains not associ-
ated with self-disclosure in individual therapy. It occurs when members
reveal personal material about their outside lives and, even more impor-
tantly, when they explore their feelings and reactions to each other in the
here and now of the group session. Appropriate and adaptive self-dis-
closure in the group is a complex function of timing, content, and reci-
procity. Therapists playa more active and self-revealing role in this
process than they do in individual psychotherapy, as they model respon-
sible personal and professional transparency in the group.

References
Bloch, S., & Reibstein, J. (1980). Perceptions by patients and therapists of therapeutic
factors in group psychotherapy. British Journal of Psychiatry, 137:274-278.
Bloch, S., Crouch, E., & Reibstein, J. (1981). Therapeutic factors in group psychotherapy.
Archives of General Psychiatry, 38:519-526.
Cohen, M., & Dies, R. (1976). Content considerations in group therapist self-disclosure.
International Journal of Group Psychotherapy, 23:71-88.
Johnson, D., & Ridener, 1. (1974). Self-disclosure, participation, and perceived cohesive-
ness in small group interaction. Psychological Reports, 35:361-363.
Jourard, S.M., & Lasakow, P. (1950). Some factors in self-disclosure. Journal of Abnormal
Social Psychology, 56:91-98.
Lieberman, M., Yalom, Y.D., & Miles, M. (1973). Encounter groups: First facts. New York:
Basic Books.
Peres, H. (1947). An investigation of non-directive group therapy. Journal of Consulting
Psychology, 11:159-172.
Query, W. (1964). Self-disclosure as a variable in group psychotherapy. International Journal
of Group Psychotherapy, 14:107-115.
Truax, c., & Carkhuff, R. (1965). Client and therapist transparency in the psychotherapeu-
tic encounter. Journal of Consulting Psychology, 12:3-9.
204 Sophia Vinogradov and Irvin D. Yalom

Worthy, M., Gary, A., & Kahn, G. (1969). Self-disclosure as an exchange process. Journal of
Personality Social Psychology, 13:59-63.
Yalom, 1.0. (1966). A study of group therapy dropouts. Archives of General Psychiatry,
14:393-414.
Yalom, 1.0. (1967). Prediction of improvement in group therapy: An exploratory study.
Archives of General Psychiatry, 17:159-168.
Yalom, 1.0. (1985). The theory and practice of group psychotherapy. (3rd ed.). New York: Basic
Books.
 v
Extratherapeutic Manifestations
 14
Criteria for Therapist Self-Disclosure
Judith C. Simon

Introduction
The psychotherapeutic relationship is unique to interpersonal relation-
ships. The role definition includes agreement that one person, the pa-
tient, will openly discuss his or her personal life, while the therapist will
function in a manner that will further the patient's psychotherapeutic
gains. The hours spent together generate a special closeness and inten-
sity, discussing primarily the patient's emotional life.
Inherent in any ongoing intimate relationship is each person's learning
about the other. Implicit to the goal of a psychotherapeutic relationship,
however, is a one-way intimacy in which the patient is the primary self-
discloser. Discussion of the therapist's personal life is not necessarily
part of the relationship. However, the therapist cannot avoid imparting
some personal information; for example, the way the office is decorated,
personal dress, the management of appointments, and nonverbal body
language all give the patient clues about the therapist.
Since therapists' personal revelations are frequently a component
of psychotherapy, questions arise regarding when, why, and what is
disclosed.
When Freud first discussed transference and, later, counter-
transference, he acknowledged the impact of the therapist'S personality
and responses on the psychotherapeutic work (1959). Therapeutic neu-
trality was the goal. Therapist self-disclosure came to be viewed as the
antithesis of the detached observer. It is important to distinguish be-
tween neutrality as a therapeutic stance and therapist self-disclosure as

Judith C. Simon • 329 South San Antonio Road, Los Altos, California 94022.

207
208 Judith C. Simon

a therapeutic technique. They are not mutually exclusive. Freud spoke

of being like a mirror but not "like an inanimate thing" (1959). The
therapist was to function as a blank screen, mirroring the patient while
adding nothing that did not originate in the patient. According to Freud,
the components of neutrality included passivity, anonymity, and mir-
roring, and these were free of countertransference distortions. Annie
Reich said (1951), "To be neutral in relationship to the patient ... does not
imply, of course, that the analyst has no relationship at all to the pa-
tient." She, among others, maintained that psychotherapy is a process
within the context of an intimate and caring relationship that can be
warm and supportive and can either include or exclude intentional
therapist disclosures.
Therapists vary greatly in how they value, define, and maintain
neutrality in their work. Currently, the trend is away from neutrality and
toward increased activity, including intentional verbal self-disclosure by
the therapist (1983). The societal trend towards a holistic approach to
health care and more equal relationships between patients and their
health-care providers have impacted psychotherapy relationships.
There is a paucity of material regarding this clinical issue. The gen-
eral body of psychotherapy literature traces the evolving thinking
within the following categories: neutrality, countertransference, the real
relationship, therapist self-disclosure, and management of special cir-
cumstances in a therapist's personal life (Yalom, 1980; Alger, 1973;
Rogers, 1961). Specific attention to therapist self-disclosure appears in
the very recent literature (Greenson, 1971; Palombo, 1987; Rosie, 1980;
Weiner, 1974). These writings cover a variety of research, including
studies with simulated patient populations, explorations with patient
populations, and anecdotal material. The literature reflects widely di-
vergent viewpoints. Agreement does not exist regarding recommenda-
tions to disclose or' not.

The Study'
I explored criteria for intentional verbal self-disclosure by experi-
enced therapists who practice long-term psychotherapy. "Intentional
self-disclosure" was defined as verbal behavior through which thera-
pists consciously and purposefully communicate ordinarily private in-
formation about themselves to their patients.
Eight experienced therapists were interviewed. "Experienced" was
defined as having 10 or more years of private clinical work. These eight
were selected by ranking 27 returned questionnaires on a scale from
high to low disclosing and choosing those four who fell at each of these
Criteria for Therapist Self-Disclosure 209

extremes. They represented the three psychotherapy disciplines of clini-

cal social work, psychiatry, and psychology.
These two groups of four therapists comprised the subjects for the
research and were labeled the high disclosers and low disclosers, re-
spectively. The demographic differences between the two groups are
worthy of note. The high disclosers were older and more experienced
than the low disclosers. There was one woman and three men in each of
the subject groups. Two psychiatrists and two psychologists comprised
the high-disclosing group and one psychiatrist, one psychologist, and
two clinical social workers formed the low-disclosing group.

Findings
Three themes, theoretical orientation, the psychotherapy relation-
ship, and therapist self-awareness, emerged from the interviews and
provide the context for the discussion of the criteria for therapist self-
disclosure.

Theoretical Orientation

Therapists' theoretical orientation was the major determinant of

therapist self-disclosure. The distinction between the two groups was
reduced to whether one viewed the psychotherapy process as focused
on working through patients' transference, or on the interconnection
between therapist and patient.
The high disclosers labeled their orientations eclectic, humanistic,
existential, and "here and now." Their mentors were Arthur Ellis, Carl
Rogers, Fritz Perls, and Werner Erhard. They viewed the therapeutic
factors in their work as truth, love, communication, understanding one-
self, and the human bond. The stance of friendliness and personal con-
nectedness was consistent with their theoretical conception of quality
psychotherapy and therapist self-disclosure was regarded as enhancing
these factors. Transference, insight, and interpretation were not useful
concepts for them.
The low disclosers considered use of transference as the integral
aspect of their work and were therefore generally opposed to therapist
self-disclosure. Many of their therapy hours are spent exploring the
patients' projections on them which they consider to be the primary
curative component in the process. One subject discussed creating a
context of deprivation:
The deprivation is important in the treatment, especially with neurotic pa-
tients, because that mode encourages their projections, so I don't want to
210 Judith C. Simon

answer their questions too quickly, it's more valuable to help them to explore.
"Deprivation" is a bad word, but that's the one Freud used. It conveys harsh-
ness. I don't mean that.

These therapists wanted to share enough not to be artificial, but not

reveal so much as to structure any more than necessary and risk getting
in the way of the patient's projections. Self-disclosure may reinforce the
social quality of the relationship and thereby burden the patient with
information to process along with fantasy.
Their mentors were Freud, Karen Homey, Frieda Fromm-Reichman,
and Ralph Greenson.

The Psychotherapy Relationship

Viewpoints about the psychotherapy are a reflection of theoretical
orientation. Both the high and the low disclosers viewed the purpose of
the psychotherapy relationship as the improved mental health of the
patient. All agreed that the therapist is an agent of change, that thera-
pists' personalities and styles are facets of the psychotherapeutic relation-
ship and that respect, empathy, compassion, and realness are essential
components of the psychotherapy relationship. They all reported that
they consciously use themselves in their work and value being real with
their patients. However, there were differences in the definition of
"realness," in views on the therapist's role, and the psychotherapy
relationship.
The intent of the high disclosers was to create a connection with the
patient that would provide a context for growth. They saw their work as
based on a real and human relationship. "Real" meant being genuine,
honest, fully open,and personally involved and not creating illusions.
These high disclosers spoke of the therapeutic relationship as a human
exchange with mutual personal sharing. "This being together, openly
sharing together, connecting, the relationship, that's what therapy is!"
said one subject. Another commented, "What really heals in therapy is
the truth." They talked about therapy as the offering of the therapist's
total self to the healing process. The high disclosers were critical of the
traditional psychoanalytic model for its hierarchical implications and its
encouragement of patient projections as the context for the work. They
valued equality in the relationship and disagreed with the traditional
neutral stance. One referred to Freud's writings as having taught him to
be respectful, caring, and equal, which he interpreted as encouraging
free disclosure. "Freud was very helpful with his patients. He talked
with them, walked with them. He was interested in their family prob-
lems and revealed some of his. He was real."
This group presented divergent opinions regarding boundaries in
Criteria for Therapist Self-Disclosure 211

the therapeutic relationship ranging from "all boundaries are open

when patient and therapist meet" to valuing the importance of respect-
ing patients' cues regarding their psychological borders. None of the
high disclosers felt that there was much difference between the psycho-
therapy relationship and a close friendship. They all were clear that
while they would not socialize with current patients, social relation-
ships with former patients were considered acceptable if desired by both
parties. This was compatible with their view that the psychotherapy
relationship ends when psychotherapy terminates.
Therapist satisfaction was a facet of the high disclosers' conceptual-
ization of the psychotherapy relationship. The more they were able to be
open and sharing participants in the relationship, the more growth po-
tential for both parties.
All the low disclosers saw themselves as "real," but in a different
sense. Their definition of real included being respectful, warm, atten-
tive, empathic, and "not dishonest"; that is, honest but not fully open.
These therapists were as clear as the high disclosers that these traits
were essential therapist characteristics, but used themselves differently.
Genuineness was discussed as conveying emotional sincerity, empathy,
and responsiveness. For these therapists, nondisclosing is not dishon-
esty, but rather reflects their commitment to neutrality as the appropri-
ate therapeutic stance. The low disclosers reported that they reveal as
little as possible without being artificial or totally depriving. They
viewed the psychotherapy relationship as separate from the real world,
but not incognizant of it. Quoting a subject:
There is an agreement that we will look at what happens in here as though it
is real. It is real, but only within the confines of this arrangement. If you have
to break the arrangement, it's sort of like the theater-the roof leaking in the
theater. Then you refund people their money, or tell them the roof is leaking.
But you don't say, "This is part of the play."

The issue of equality in the psychotherapy relationship elicited

strong reactions from the low-disclosing therapists as well as the high
disclosers. They were cognizant of the fact that their neutral stance
evokes criticism and suggests that they present themselves as superior
to their patients. These therapists insisted that equality-inequality is not
the issue. When the patient is enabled to understand that the therapist is
being supportive and empathic while encouraging transference, a sense
of teamwork emerges, not hierarchy. While it is true that both patient
and therapist are equal in terms of their human rights and the complex-
ity of their psychological makeup, the therapist is more expert than the
patient in the realm of emotional problems and their solutions. To deny
this is to deny the validity of one's own training.
Consistent with their viewing the psychotherapy relationship and
212 Judith C. Simon

their roles in it as distinguished from other relationships, these thera-

pists were opposed to socializing with current or former patients. They
did not regard the professional relationship as ending when therapy is
terminated. Patients were thought to carry an incorporation of their
relationship with their therapists that would be tainted by another kind
of contact. Additionally, these therapists assumed a professional duty to
not contaminate the patient/therapist relationship in a manner which
could preclude a patient's freedom to return to therapy.

Therapist Self-Awareness

The two subject groups held contrasting viewpoints about therapist

self-awareness. Consistent with this, the high disclosers had considerably
fewer hours of personal psychotherapy experience than the low disclosers.
The high disclosers, in regarding the psychotherapy relationship as
mutually satisfying for therapist and patient, felt that it was less significant
whose material was being discussed than that the patient and therapist
were interacting in a deep and meaningful way. This connection pro-
vides the context for their own growth along with their patients'. Personal
psychotherapy was indicated only when the therapist faced a crisis.
Therapists who utilize transference as the primary material believe
that they have to be maximally self-aware to minimize distortions. One
statement reflected the sentiment of the group: "I have to know what's
mine and what's the patient's."
These therapists addressed their self-questioning before revealing
themselves. They acknowledged an occasional pull to share special
news with patients. One subject described his personal joy after the
birth of a son and his wish to share that with any interested person.
"But it wasn't my place to discuss that with patients, it was my wish,
and I had to be able to contain it. I was sufficiently aware of my personal
need and the conflict it caused in me ... so I went back to my therapist."
The two groups clearly utilize different models, viewpoints, and
paradigms in their psychotherapy practices. Internal consistency within
each group was high as they discussed their concepts of the psycho-
therapy relationship, their theoretical orientations, and personal aware-
ness. This consistency persists in the findings specific to the criteria for
therapist self-disclosure.

Criteria
All eight subjects self-disclosed at times and utilized the same crite-
ria for self-disclosure. The differences emerged in the therapists' indi-
Criteria for Therapist Self-Disclosure 213

vidual determinations regarding when, what, and why to self-disclose.

Frequency of self-disclosure varied widely and was a function of thera-
pists' theoretical orientations. Decisions to self-disclose were based pri-
marily on clinicians' conceptualizations of the curative components in
psychotherapy, or what several stated as lithe way I do therapy."
The high disclosers were quick to share themselves. Their orienta-
tion prescribed that the indications for self-disclosure were ever-present
and they were not as contemplative of their reasons for disclosing or as
concerned about supplying as firm a theoretical basis for their criteria of
disclosing as were the low disclosers.
This same phenomenon was observed in the interviews. When
asked why they might disclose something, the high disclosers fre-
quently responded quickly by saying, "I just do," whereas the low dis-
closers paused, thought, and gave a response such as, "I do that because
it furthers the patient's sense of reality." In contrast to the low disclosers,
none of the high disclosers labeled therapist self-disclosure a psycho-
therapy technique.
Five categories of criteria emerged from the subjects: to model and
educate, to foster the therapeutic alliance, to validate reality, to encourage
the patient's autonomy, and, for the high disclosers only, therapist per-
sonal satisfaction. Clearly, there was overlap among the criteria utilized
in this study: responses were categorized by their most prominent feature.

Modeling
Modeling emerges as the most common criteria for therapist self-
disclosure. Therapists reported that they often served as models of adult
behavior by demonstrating problem-solving approaches, coping skills,
self-acceptance, and assertiveness. All of the subjects said that they
used self-disclosure to model more frequently with adolescent patients
than with adults because of the adolescent's need for help with the
developmental task of becoming more autonomous. Identification with
the therapist was viewed as helping patients face life and was encour-
aged by the therapist's appropriate self-disclosures.
Both the high and low disclosers felt that handling an error made
with a patient presents therapists with an important opportunity to
model the ability to err and the capacity to apologize.
The high disclosers felt modeling was an essential component of
psychotherapy and that by showing their patients their own honesty
and openness they were modeling relationships in general. One subject
wanted to model someone who was transparent and who could demon-
strate a way to live without fear or secrets, a stated psychotherapy goal
214 Judith C. Simon

of his. They believed that good therapists are models and in so being,
communicate to their patients, "You can do these things, too."
These therapists freely disclosed personal information to illustrate
behavior in specific situations in addition to modeling openness in gen-
eral as essential to a functioning relationship.
Personal information was readily offered, especially to adolescent
patients, and these therapists viewed this as re-parenting and/or educa-
tion about the adult world. Personal experiences of their teen years
which paralleled their patients' were freely disclosed. Adolescents'
questions about the therapist's experiences in the adult world were also
responded to fully. Examples cited were career evolution, earning ca-
pacity, and marital problems.
I explored use of therapist self-disclosure when there are stressful
circumstances in the therapist's life. All high disclosers felt that it was
very important to fully disclose information about these kinds of crises,
primarily to model a way of coping. "Teach them how to deal with it,
including what you did that helped and what you did that didn't help."
In the same vein, two of these subjects recommended revelation of infor-
mation about any personal crisis or significant occurrence. "I might
even reveal that I fight with my wife. People don't often know that it's
okay to get angry at someone close."
Fewer examples of modeling were presented by the low disclosers,
although modeling was also their primary criteria for self-revelation.
While they rarely self-disclose in order to model with neurotic adult
patients, modeling with adolescent patients was an appropriate devia-
tion from their usual nondisclosing stance. For example, "Some of these
kids haven't had decent adults to look up to. If I can provide that, I'm
not going to withhold because I'm a Freudian." They freely told stories
about their own adolescence to offer themselves for identification.
One therapist said that he sometimes shared a personal experience
that showed his bad judgment to model that "even the idealized thera-
pist is not a perfect person."
All of these subjects have shared their own reactions to difficult
personal situations in order to indicate that their patients' intense feelings
were appropriate. Examples included their emotions in responding to
the death of a parent and the frustrations and fatigue of early parenting.
Three felt that they would model with more disturbed patients to
show them ways of coping with specific situations. The emphasis was
on specific. These therapists were inclined to share emotions with this
population to demonstrate that emotional responses were, indeed,
sometimes appropriate. A common example was "That would make me
angry too." They did not present themselves as overall objects of identi-
fication. Encouraging imitation in social situations, for example, dining
Criteria for Therapist Self-Disclosure 215

out, and interactions with co-workers, were also uses of therapist self-
disclosure with the purpose of modeling.
Two of these therapists felt that universalizing was a successful tool
to reduce some insecurities, and that they included themselves as
models in this respect. "Sometimes we're just at the mercy of the powers
that be" was a common phrase.

Fostering the Therapeutic Alliance

Fostering the therapeutic alliance was the second most common

criterion cited. All of the subjects reported that they were more inclined
to disclose early in the psychotherapy process for this reason. Patients
often ask for specific personal information during the first or second
interview and this was universally viewed as expression of the patient's
anxiety and need to assess the trust potential with the therapist. The
manner in which the subjects responded to these kinds of questions
varied according to their theoretical orientations.
The high disclosers willingly gave whatever information patients
requested during any phase of treatment. In the early stages, their
purpose was to reduce alienation, lessen patients' anxiety and establish
the working alliance. The therapists saw this as critical for the building
of trust and communicating to patients that they were genuine, human,
and real. They expressed their strong commitment to being truthful and
honest in every situation, and stated that the therapeutic alliance de-
pends on this absolute honesty. Understanding and empathy were
viewed as facets of the working alliance, and these therapists disclosed
to convey their compassion.
Patients' curiosity was respected. This quote reflected the senti-
ment of the high-disclosing therapists: "Curiosity makes sense. I think
people are particularly anxious when they come to a therapist ... want-
ing to know who they are dealing with." Not answering questions
would be offensive and increase rather than reduce anxiety. The sub-
jects could not cite a reason not to reveal anything that was asked.
Self-disclosures were discussed as a tool to end impasses. Respond-
ing to a patient's perception of never being understood by sharing a
similar experience or feeling can enable the work to progress. One thera-
pist related listening to his patient talk about an early jail experience.
This therapist had had a similar experience as a young adult and be-
came aware that the patient's material elicited an intense reaction that he
was unable to contain. He chose to share his experience to refocus his
attention on the psychotherapy.
All high disclosers speculated that their way of handling having
received a black eye in a fight would reflect their interest in fostering the
216 Judith C. Simon

therapeutic alliance. "I'd be embarrassed ... but honesty is very impor-

tant. It's a matter of them believing me or not, and they must believe me
and my honesty. I'd tell the truth." When asked if they might equivocate
about the details with any patient, they all hesitated, and concluded that
they would have to be truthful.
The determination not to disclose was reported as sometimes being
in the interest of maintaining and/or furthering the therapeutic alliance.
They reported specifically withholding personal information for this
reason. For example, two said that they wouldn't share their news of
prospective grandparenthood with a woman who was experiencing fer-
tility problems because that information was potentially painful. These
high disclosers were clear that they would not reveal personal sexual
information, considering such disclosures inappropriate to most social
interactions. Allowing an invasion of their privacy would alter their
objectivity with their patients and interfere with the therapist-patient
connection. These subjects' deviations from their usual stance of abso-
lute honesty reflects a conceptualization of their professional bound-
aries which was not otherwise apparent.
Self-disclosing interventions to further the therapeutic alliance
were less frequent for the low disclosers, except for early sessions. In the
interests of not adding to their patients' anxiety at the outset of therapy,
these therapists stated that they would probably answer demographic
questions during the first session. One subject said that he would an-
swer personal questions out of courtesy, explaining that until the thera-
peutic alliance and agreements were set, the usual social manners were
necessary. One presented this in terms of the patient's need to feel
secure and comfortable. "I think of this more like a character analysis of
the person, and then what type of information that person will need to
feel secure./I
They were clear that they would rather not answer these questions
but acknowledged that they usually did. Several subjects reported that
the way in which they refused to respond to early inquiries laid the
groundwork for establishing the therapeutic agreements. "I might use a
patient's question, straightaway, as an opportunity to show him that I
won't readily reveal, and that nonrevealing on my part is an aspect of
the process./I
In general, patients' curiosity was seen as an opportunity for fur-
ther exploration. They all felt that if the material was fully explored and
still seemed very important for the patient, that they would briefly share
it. This applied to inquiries about their personal data and to observa-
tions about their state of health. One expressed a common feeling: "I
don't think there's any point in being mysterious for its own sake./I
Furthering the therapeutic process when there is an impasse was
Criteria for Therapist Self-Disclosure 217

reported as a criterion for self-disclosure by these low-disclosing thera-

pists. In this regard, one said, "I share only if the patient's progress is
being totally hampered by something related to my personal life." One
said that he might share that he'd had good news, if the patient ~eemed
sidetracked by his good mood. "It would probably get me back on track
too. It would discharge it in the moment and get us both back to work."
Responding to the hypothetical vignette about the black eye, these
therapists felt that this was exactly the kind of situation where their
disclosure would close off a valuable opportunity for the patient's
exploration.
This group saw their decisions not to disclose as protection of the
therapeutic alliance. Because maintaining the therapist-patient bound-
ary was an aspect of the alliance, they were careful not to blur it by
introducing irrelevant personal material.
Establishing and maintaining the alliance with low functioning pa-
tients was discussed as an aspect of the determination to self-disclose.
One subject discussed his work with disturbed patients who sometimes
"needed" personal information "to maintain a state of homeostasis
within the therapeutic hour." One of the low disclosers stated that his task
was to help them with boundary issues and that he would "gently and
minimally disclose and inquire why they needed to know, and what if they
didn't know." In work with ego-impaired patients, strictness about self-
disclosure was seen as potentially threatening to the working alliance.
Sometimes the patient's refusing to know anything about the thera-
pist and not asking for a disclosure was viewed as significant to the
alliance. Examples included a therapist's broken arm and patients who,
over the years, never ask anything. These therapists regard these occur-
rences as appropriate times to explore why the patient didn't want to
know. In these instances, the subjects said that they probably would
reveal some information.

Validating Reality

One of the goals of psychotherapy, as reported by the therapists in

the study, is the enhancement of the patient's ability to cope with and
respond appropriately to reality factors. However differentiated the psy-
chotherapy relationship may be from the outside world, the impact of
reality factors on the psychotherapy process cannot be ignored. Both
groups reported therapist self-disclosure as a technique to enhance pa-
tients' abilities to deal with real-life occurrences. Special reality circum-
stances may arise in the therapist's life during the course of
psychotherapy that demand some response by the therapist.
The high disclosers, in their particular view of "truthfulness" in
218 Judith C. Simon

psychotherapy, felt that validation of the patient's reality remained an

important aspect throughout the psychotherapy process. By being open
and truthful they were always facilitating the patient's grasp of reality.
One subject said that such disclosures help "patients to be able to vali-
date their perceptions of what's going on with me. If they're wonder-
ing-the more feedback I can give them, the more accurate they can be
about 'that's my stuff and the other stuff is her stuff'."
Subjects were asked how they would respond to a patient's com-
ment, "You look ill. Are you okay?" All said that they would answer
directly to confirm their patients' perceptions with enough detail to
make it real for patients. Responses ranged from a simple, "I'm a little
sleepy" to including details, for example, "My kid was up a lot last night
and I didn't get much sleep." Two subjects said that they would then
explore the meaning of the query for the patient. The other two felt that
the question reflected the patient's sensing something awry and they
would respect and confirm the patient's perception by saying something
like "I guess I am sluggish today."
Circumstances do arise during the course of therapy that necessi-
tate direction by the therapist. The subjects were asked how they would
handle their illnesses, vacations, and special occasions in their lives.
These high-disclosing therapists have shared and believe that therapists
should disclose fully about their own illnesses and absences from work.
Consistent with their orientations that the truth heals, and that experi-
encing reality with the therapist enhances the patient's ability to react to
personal reality, these therapists freely disclose children's weddings,
toothaches, marital problems, surgery details, and deaths of loved ones.
The low disclosers acknowledged that reality sometimes intrudes,
even for psychoanalytic psychotherapists. These subjects felt that to
pretend that their personal reality is a facet of the patients' projections is
to confuse and betray the patient. As noted above, the kinds of realities
that the therapists enumerated related to therapists' illness, losses, and
joys. The low-disclosing therapists were in agreement that they had to
validate their patients' reality when they made observations that were
accurate. To ignore their observations undermines their ability to trust
themselves in relationships. Therefore, they would share minimal infor-
mation. In response to "You look ill. Are you okay?" these subjects all
agreed that they would first explore the patient's motivation behind the
question and then share truthfully and briefly, if indeed they were feel-
ing less than well. They would not volunteer any details.
In managing their own illness, these subjects felt that the informa-
tion patients requested related to their needs to know what was going to
happen to their treatment. One said, "I'd recommend disclosure of
enough to allow the patient to deal with it realistically. When you're sick
Criteria for Therapist Self-Disclosure 219

you're going to have to violate the contract, the frame, involuntarily, and
that's different from a patient wanting to have information." A patient
failing to ask about an obvious injury to the therapist could be viewed as
an avoidance of reality. These subjects felt that they would reveal some
information in this situation to push the patient to confront reality.

Encouraging the Patient's Autonomy

Although not as frequently cited as the above criteria, therapists

commonly use self-disclosure to increase a patient's sense of self.
Consistent with the high disclosers' commitment to openness,
these therapists felt that self-disclosures communicated respect for their
patients' autonomy as well as their own. An aspect of this was their
belief in equality between therapist and patient and this was reported to
be most successfully communicated through personal disclosures. They
wanted to let patients know that they were regarded as peers. One
therapist said, "When I tell a patient about my life, I am telling him
'I like you, I trust you, I respect you.' That's got to make him feel like
a mensch!"
These high-disclosing therapists also mentioned withholding per-
sonal revelations to be respectful of their patients' autonomy. They were
careful not to be intrusive with revelations that could be painful or
overload a fragile patient.
The low disclosers reported that respect for patients was communi-
cated by their demeanor, commitment, and attentiveness. Management
of errors the therapist makes provides an opportunity to encourage
patients' autonomy. These clinicians would acknowledge an error and
apologize, thereby imparting to patients that they are entitled to respect.
Equality is not a consideration. As noted above, these therapists do regard
their patients as equal human beings who seek the therapist's expertise.
Diagnosis was a major factor in these therapists' determination to
disclose with the purpose of enhancing patients' autonomy. All the
examples given referred to patients labeled "low functioning" or "bor-
derline," who needed to see their therapists as whole persons. Sharing
information about location of vacations with borderline patients was
generally regarded as an appropriate self-disclosure. They also ad-
dressed patients who need to merge as a part of the psychotherapy
process. "Sometimes that's manifest in wanting to know a lot about you.
And I would probably gently help them with those boundaries. I would
give them information, briefly, and inquire why they felt they needed to
know." One of the subjects commented that, with this purpose in dis-
closing, timing was more important than what was revealed.
220 Judith C. Simon

Therapist Satisfaction
While all the subjects reported satisfaction from their work, the fulfill-
ment derived from practicing psychotherapy was different for the thera-
pists in the two groups.
The high disclosers were very clear about the gratification they
obtained from their patients. They chose orientations that support thera-
pist openness, and it is the mutuality of openness in the psycho-
therapeutic relationship that provides much of their professional
satisfaction. They acknowledged their own enjoyment of their friendly
relationships with patients and their belief that therapist and patient
both grow in the relationship. Therefore, their conceptualization of crite-
ria for therapist self-disclosure was casual and relatively unstructured.
Two of these therapists said that they would pursue discussions
with patients about most topics of interest to the therapist. For example,
they agreed that they would elicit information about a patient's vacation
if the destination was of personal interest.
The low disclosers also reported satisfaction from the psycho-
therapy relationship. However, therapist satisfaction was not a criterion
for self-disclosure. For them, it was the psychotherapy process and rela-
tionship, including intellectual stimulation, that provided fulfillment.

Discussion
The original research question, "What are the factors in therapist
self-disclosure?" can be answered concisely. The main factor is therapist
theoretical orientation. At the same time, it is clear that this concise
answer, while accurate, is inadequate. Numerous other factors impact
therapist disclosure. Theoretical orientation, the psychotherapeutic
frame, the psychotherapeutic relationship, the therapist's personality,
and therapist self-awareness are all themes associated with therapist
self-disclosure.
The four high-disclosing therapists defined their orientations simi-
larly: they agreed on loose boundaries between themselves and their
patients; they opposed therapeutic neutrality; they espoused equality;
and they were active participants in the interchange between them-
selves and their patients. The four low-disclosing therapists also defined
their orientations consistently: they agreed about defined boundaries;
they valued neutrality; and they believed in being fairly inactive in
interactions with their patients to encourage transference.
Attitudes about transference both exemplified and were crucial to
the differences between the two subject groups. Therapists who believe
that transference work is the crux of the psychotherapy process self-
Criteria for Therapist Self-Disclosure 221

disclose minimally. Therapists who reject transference work do not hesi-

tate to self-disclose.
Viewpoints about the psychotherapy frame were consistent with
the above distinction. That the high disclosers were more casual about
boundaries was evident in their attitudes about time, money, personal
artifacts in their offices, and telephone calls. The low disclosers, consis-
tent with their neutral frame, maintained this stance with regard to
time, money, office decor, and calls.
The low-disclosing therapists were more contemplative about their
roles in the psychotherapy process. These clinicians were frequently
silent for several moments during the interviews, obviously thinking
about their responses. This behavior reflected their general stance of
thoughtfulness and intentionality when self-disclosing. In contrast, the
more spontaneous responses of the high disclosers were seen as being
congruent with their stances and their less self-reflective styles.
The issue of the "real" relationship within the psychotherapeutic
relationship was viewed very differently. A therapist who is real, as de-
fined by the high disclosers, adheres to a code of truthfulness and genu-
ineness. Such a therapist actively uses him or herself and freely discloses
personal information. In contrast, the low-disclosing therapists' concep-
tualization of "real" in psychotherapy meant the actual person-to-person
relationship, and "genuine" meant being direct, attentive, respectful,
and responsive to patients. This "realness" can be manifest without self-
disclosure.
Equality as an aspect of the psychotherapeutic relationship under-
lies the topic of therapist self-disclosure. Is the therapist suggesting his
or her own superiority by being neutral?
High-disclosing therapists regard their use of self-disclosure as an
important way to communicate their care, respect, and parity with their
patients. According to their thinking, therapists who maintain neu-
trality and do not share themselves are withholding respect and care
and are elevating their own status.
For low-disclosing therapists, maintenance of the neutral stance is
consistent with their theoretical orientation, and not a technique to
establish superiority. They are no less committed to communicating care
and respect to their patients, but feel that this is accomplished by their
undivided attention and adherence to a professional style that they re-
gard as the most facilitative of patients' growth. As human beings they
are equal to their patients; as professionals they contribute their exper-
tise and, in that regard, they are not equal (Weiner, 1983).
When and why a therapist self-discloses is also an extension-and/or
reflection of the therapist's personal style. In this study, the four high
disclosers were very interactive and congenial. They were unusual and
222 Judith C. Simon

colorful personalities who were "out front" with their likes and personal
philosophies. The interviews were entertaining, lively, and lengthy. In
contrast, the low disclosers' interviews were briefer and more focused.
They were more formal and restrained (neutral?) in their manner. These
interviews were less lively and more intellectually provocative.
Offices were decorated in a manner consistent with orientations.
For example, one high discloser proudly displayed family photographs.
Another had numerous art objects reflecting an ethnic interest. These
therapists had more desire to share themselves and did so physically
as well as verbally. The low disclosers' offices were austere by compari-
son. Colors were more muted and the displayed art less reflective of
personal taste.
One can question which office style is more appropriate and/or
supportive of psychotherapeutic work. Clinicians and patients must feel
comfortable and supported in the therapist's office. The therapist's at-
tention to the physical environment is important, whether it be a clear
reflection of the therapist as a person or an aspect to support the thera-
pist's professional stance. Sensitivity to one's patient population was
considered. The therapists' personal dress also reflects the therapist as a
person and, in this study, their attire was consistent with their orienta-
tion and office decor.
Therapist self-awareness was assessed by the questioning of per-
sonal psychotherapy experience. There appeared to be a relationship
between valuing self-awareness and working with transference. When
working within a neutral frame and encouraging patients' transference
projections, knowing oneself is important. The high disclosures did not
regard self-awareness as being related to their professional functioning.
The fact that all the subjects utilized similar criteria for therapist
self-disclosure and that all the subjects did self-disclose leads to the
conclusion that self-disclosure is a fact in most psychotherapy. The sim-
ilarity in the purposes of therapist self-disclosure expressed by all the
subjects blurs some of the striking differences between the two groups.
The high disclosers did not think through their processes in making
disclosures because they valued overall openness. They were not con-
cerned about being too revealing since they considered self-revelation
an integral component of the therapy process as well as their personal
styles. For the low disclosers, intentional self-disclosure demanded
thought. It was this discriminative thinking process in contrast to readi-
ness to self-disclose that differentiated the two subject groups.
Several further issues emerged from this study. Diagnosis as a facet
of therapist self-disclosure was explored. All the subjects gave less at-
tention to it than to the other criteria, which leads to the tentative con-
clusion that diagnosis is a minor criterion.
Criteria for Therapist Self-Disclosure 223

Stage of therapy also emerged as a minor criterion. All subjects

reported that they were more likely to disclose in the early phases of
psychotherapy either to further the alliance, relieve the patient's ten-
sion, or to be courteous. The mention of courtesy suggests that there is a
period of adjustment to the psychotherapy process to which therapists
are sensitive.
The issue of physical touch between therapist and patient, although
not part of this study, can be viewed as a facet of therapist self-
disclosure. Several subjects did mention touch. Three of the low dis-
closers indicated they never have physical contact with their patients.
The high disclosers volunteered that they often hug a patient on leaving
and, consistent with their styles, if they feel like making physical con-
tact, they do. (There was no suggestion that any of this physical contact
went beyond casual touch.)
The managing of reality within the psychotherapy context presents
a challenge, as was confirmed by the literature and the findings. Thera-
pists' intense personal stress impinges upon professional functioning.
The "appropriate" way to manage this is probably consistent with one's
theoretical orientation, but our reality, as therapists, is that we, too, can
be overwhelmed with our own personal stresses and not respond in the
optimal manner with respect to our patients' well-being.
There is an absence of agreement regarding the management of
personal circumstances in the therapist's life. Divergent recommenda-
tions and experiences are represented in the study and the literature
(Abend, 1982; Dewald, 1982; Flaherty, 1984; Goldberg, 1984; Weiner,
1974). I have experienced fall out from another therapist's inability to be
professional while he was coping with a terminal illness. This raises the
issue, how to respond to a patient who had such an experience with a
previous therapist? How much, if anything, should be disclosed about
the former therapist's illness and his/her struggle to be professional
while personally stricken? Can we expect ourselves to maintain a pro-
fessional stance when we are in great physical and/or emotional pain?
What is the impact on our patients of being real, i.e., self-disclosing, in
these situations?
The issue of patients liking the therapist is a thread that was evident
in this research and in the surveyed literature. It is possible that an
aspect of the high disclosers' friendly style is wanting to be liked by
their patients. Studies suggest that some patients like therapists who
self-disclose, but that liking one's therapist does not correlate with suc-
cessful psychotherapy outcomes (Simonson, 1974; Truax, 1971). This
raises questions regarding patients' selection of therapists. How do and
how should prospective patients go about selecting a therapist?
There is clinical value in therapists becoming more aware of the
224 Judith C. Simon

early process of assessing their patients. The distinction between coun-

seling and psychotherapy suggests a very different use of therapist
self-disclosure. The counseling process connotes briefer, less in-depth
exploration with more emphasis on coping skills and environmental
manipulation. Modeling, the most frequent criterion for self-disclosing,
is a very successful technique in this kind of work. Psychotherapy, on
the other hand, is usually more insight-oriented, and therefore self-
disclosure to foster the alliance is the most relevant criterion. The lack of
confidence in utilizing therapist self-disclosure might be addressed by a
clearer conception of the kind of therapy being practiced. The low dis-
closers, with their basic anti-disclosure viewpoint, might be excluding a
useful tool in their supportive or counseling work with some patients.
Further study might contrast experienced therapists with begin-
ners. Less experienced therapists may not have clearly conceptualized
their theoretical orientations and their frequency of disclosing may re-
flect their personal styles and/or anxieties. Therapists who are mod-
erately experienced are probably, as a group, the least disclosing. They
may be trying the hardest to adhere to classical teachings and maintain
a professional stance.
Highly experienced therapists, as suggested by this study, make
determinations regarding self-disclosures in a manner consistent with
their professional conceptualizations as evolved from years of study,
personal growth, and clinical practice.

References
Abend, S.M. (1982). Serious illness in the analyst: Countertransference considerations.
Journal of the American Psychoanalytic Association, 30 (2), 365-379.
Alger, I. (1973). Freedom in analytic therapy. Current Psychiatric Therapy, 9, 73-78.
Dewald, P.A. (1982). Serious illness in the analyst: Transference, countertransference, and
reality responses. Journal of the American Psychoanalytic Association, 30 (2), 347-363.
Flaherty, J.A. (1984). Self-disclosure in therapy: Marriage of the therapist. International
Journal of Group Psychotherapy, 34 (2), 442-452.
Freud, S. (1959). Recommendations to physicians practising psychoanalysis. In E. Jones
(Ed.), Collected papers, Vol. II. New York: Basic Books.
Goldberg, R (1984). Personal observations of a therapist with a life-threatening illness.
International Journal of Group Psychotherapy, 34 (2), 389-396.
Greenson, R.R. (1978). The real relationship between the therapist and the psychoanalyst.
In R.R. Greenson (Ed.), Explorations in Psychoanalysis, New York: International Uni-
versities Press.
Palombo, J. (1987). Spontaneous self-disclosure in psychotherapy. Clinical Social Work Jour-
nal, 15 (2), 107-120.
Reich, A. (1951). On countertransference. International Journal of Psychoanalysis, 32, 25-31.
Rogers, C.B. (1961). The concept of a fully functioning person. In C.B. Rogers (Ed.), On
becoming a person. Boston: Houghton Mifflin.
Rosie, J.S. (1980). The therapist's self-disclosure in individual psychotherapy: Research
and psychoanalytic theory. Canadian Journal of Psychiatry, 25, 469-472.
Criteria for Therapist Self-Disclosure 225

Simonson, N.R., & Bahr, S. (1974). Self-disclosure by the professional and paraprofession-
al therapist. Journal of Consulting and Clinical Psychology, 42, 359-363.
Truax, C.B., & Mitchell, K.M. (1971). Research in certain interpersonal skills in relation to
process and outcome. In A.E. Bergin & S.L. Garfield (Eds.), Handbook of psychotherapy
and behavior change: An empirical analysis. New York: John Wiley.
Weiner, M. (1972). Self-exposure by the therapist as a therapeutic technique. American
Journal of Psychotherapy, 31, 42-51.
Weiner, M. (1974). Personal Openness with Patients: Help or hindrance. Texas Medicine, 76,
60-65.
Weiner, M. (1983). Therapist disclosure. Baltimore: University Park Press.
Yalom, 1.0. (1980). Existential psychotherapy. New York: Basic Books.
 15
Self-Disclosure in Holocaust Survivors
EFFECTS ON THE NEXT GENERATION

Arlene Cahn Gordon

Introduction
The Holocaust was woven into the fabric of life.
It was always there. The natural tapestry of my life. It was my first memory.
There was never a time in my life where there wasn't an Auschwitz.
It was very much a part of my life. Growing up I wondered what it was like
not to be a child of a survivor.
It was always a way of splitting time. Before the war and after the war.

No child is born in a vacuum. As a child grows, she becomes aware of the

culture of which she is a part as she simultaneously distinguishes her
own place within and her effect upon that culture. A child's entry into
culture is facilitated by her parents. As is evident in the above quota-
tions, children of Holocaust survivors enter a world that is colored by the
Holocaust. An event they did not directly experience is felt to be a
pervasive part of their own lives.
I suggest that the manner in which the Holocaust is negotiated
between parent and child, the way it is "woven into the fabric of life," is
related not only to the child's understanding of the world, but of herself.
The study discussed in this chapter concerns the relationship between
self-disclosure in survivor parents and their children. I will present
evidence that suggests that the manner in which survivors disclose their
Holocaust experience is related to their children's ability to disclose their

Arlene Cahn Gordon. 15 Dogwood Drive, West Orange, New Jersey 07052.

227
228 Arlene Cahn Gordon

own experiences. It is this ability to disclose or acknowledge one's own

experience that is considered of central importance in facilitating inti-
mate relatedness with others and, in a different sense, with oneself.

Self-Disclosure in Stages of Survival

Those who survived the Holocaust endured a systematic attempt to
strip them of every fiber of their humanity. They experienced constant
fear and anxiety regarding their fate, uprooting, and loss of family,
friends, and possessions. In the majority of cases they suffered physical
and psychological brutality. After living through the horrendous
traumas of the war, survivors were faced with rebuilding their lives and
their sense of trust in a world gone mad before their eyes. For many,
getting married and having children became a way to reenter the world
of the living and compensate for the incomprehensible losses (Freyberg,
1980). Rushing into these "marriages of despair" (Danieli, 1982) often
led to placing all hope on the children. When survivors became parents,
they assumed the universal role of introducing and sharing their world
with their children.
Let me start, as do children of survivors throughout their lives, with
an attempt to understand the role of self-disclosure in survivors, at each
of the stages described above. Self-disclosure is viewed here as an ac-
knowledgment of experience to oneself and/or to others. It includes two
processes: first, the symbolizing of experience, a process of maintaining
verbal or nonverbal representations of experience within an individual;
and second, the acknowledgment or naming of experience by linking
internalized representations of all kinds to words. Those who survived
one of the worst assaults on humanity had to rework these essential
human tasks, those of self and other-directed disclosure, at each stage
of their lives. Observing their monumental task highlights the inextrica-
ble link between self-disclosure and intimate relatedness within and
across generations.
During the war individuals had to alter the way they interacted with
and reacted to the world. Consider those who survived internment.
Authors consistently describe a series of stages through which concen-
tration camp prisoners passed (Bettelheim, 1960; Chodoff, 1963; Frankl,
1959; Krystal, 1968; Niederland, 1968). Essentially, they describe the
breakdown, by external observation, of relatedness with oneself and
one's world. Initially, prisoners experienced an acute fright reaction
which resulted in a dazed state and depersonalization. This phase was
followed by a period of apathy and emotional numbing. Krystal main-
tains that those who survived did so on the basis of automatization of
Self-Disclosure in Holocaust Survivors 229

functions, and restriction of cognitive and emotional life solely to the

task of survival. The feelings ceased to be, on the surface, because one
could not live with such feelings of disgust and terror. On some level,
acknowledgment of one's experience, which is proposed as critical to a
sense of relatedness, was so intolerable it actually interfered with
adjustment.
Emotional numbing to external reality is thus viewed as one coping
mechanism necessary for survival. What was it that helped survivors
maintain the will to live, given the necessity of what Eitinger (1961)
refers to as "psychic anesthesia"? A key variable in survival may have
been survivors' ability to rely on internalized experience. Eagle (1984)
suggests that the cognitive-affective links provided by both interper-
sonal relations and by interests and values contributes to psychological
integrity in extreme conditions. When normal interpersonal relations
are disrupted, values and interests which have been internalized be-
come even more crucial in survival.
Rapaport (1958) talks about the "stimulus nutriment" needed by the
ego in order to function. The ego maintains autonomy from the id by
"stimulus nutriment" from the environment, and the ego maintains
autonomy from the environment by "stimulus nutriment" or affective
signals from the id. Those experiencing sensory deprivation, for exam-
ple, fare better if they are capable of engaging in fantasy and reverie.
Inmates of concentration camps who were able to sustain a rich inner
life were better off than those who, without "stimulus nutriment" from
their inner life, were more dependent on the environment, which in
their case was intolerable. In explaining the usefulness of escaping from
the environment by dependency on an inner life, Eagle (1984) states that
"because the very inner life into which one escapes, by its very nature, is
characterized by (internalized) cognitive and affective links to others,
one's retreat is personal and yet not autistically personal" (p. 193).
Eagle's discussion helps resolve an apparent contradiction between
types of behavior necessary for survival. On the one hand, there was
tendency to become numb, to remain apathetic, and to deny the horrible
thoughts and feelings about one's experience. One the other hand, indi-
viduals survived by maintaining an investment in ideals, in fantasy-in
an inner life. Survivors cut off their cognitive-affective links to current
reality, but retained the links to internalized objects.
The capacity to maintain internal representations of once-present
objects in their absence, first achieved when a child develops object
constancy, is dependent on symbol formation. Those who survived
maintained their capacity to symbolize experience. These symbolizing
processes were the crucial factor that allowed them to remain related, by
reliance on internalized objects.
230 Arlene Cahn Gordon

What happened after liberation? Making the transition from exces-

sive reliance on fantasy and internalized objects to the reality of their
current world and the possibility, indeed necessity, of establishing new
relationships, led to severe emotional turmoil for many. Included in that
turmoil was the difficulty of acknowledging what had happened to their
lives, to themselves, and to others. While I will highlight some of the
hurdles to appropriate acknowledgment of experience, it is important to
emphasize the great variation with which survivors met and overcame
them. The numerous books, studies, and first-person accounts by sur-
vivors, for example, attest to the ability, commitment, and strength of
many to disclose their experiences.
One extremely difficult area of acknowledgment was mourning for
those who died. Survivors were generally unable to mourn during the
war. Their very survival was at stake, and they were unable to acknowl-
edge their losses while saving themselves. After the war, the magnitude
of their losses, the necessity to rebuilt their lives, and the overwhelm-
ing, unmanageable nature of their feelings often prevented adequate
mourning. Rlein (1971) states that most survivors experienced despair,
suicidal thoughts, and fantasies of bringing lost relatives back to life and
obtaining revenge. Denial of the death of loved ones ensued.
Freud (1917), discusses depression resulting from loss in terms of a
failure to form symbols. In his paper "Mourning and Melancholia," he
states that "the melancholic displays something else besides which
is lacking in mourning-an extraordinary diminution in his self-
regard ... In mourning it is the world which has become poor and
empty; in melancholia it is the ego itself" (p. 246). Freud suggests that
the various self-accusations of the melancholic are really reproaches
against a loved object, which have been shifted from the abandoned
objects onto the melancholic's own ego. There is an identification of the
ego with the abandoned object. By self-punishment, melancholics suc-
ceed in "taking revenge on the original object and in tormenting their
loved one through their illness, having resorted to it in order to avoid the
need to express their hostility to him openly" (p. 251).
Freud's conceptualization of melancholia stresses turning against
the internalized object, which I relate to turning against the symbol.
The importance of maintaining internalized objects, discussed by Eagle
(1984), is here threatened. The survivor may not let the internalized,
symbolized object survive, but turns against his/her own ego by identi-
fication with the lost object. From this perspective, a survivor who
cannot acknowledge his/her losses has lost, a sense of relatedness or
intimate connection with not only significant others from hislher life,
but with a part of himlherself.
Following the war, survivors also faced a kind of "turning against
Self-Disclosure in Holocaust Survivors 231

the symbol" from external sources. Danieli (1982) states that survivors
encountered negative reactions and attitudes thatled to a "conspiracy of
silence" about the Holocaust. The survivors' experiences were too horri-
fying for most people to listen to. Even those who consciously wanted
to listen, avoided asking questions, which they rationalized by a belief
that they didn't want to add to the survivors' pain. Danieli discusses the
consequences of this conspiracy of silence for survivor families. Feeling
betrayed by the inability of their relatives to share their sense of loss,
grief, and rage, survivors felt even more isolated. Some survivors had
sustained the horrors of the war in order to bear witness: the imposed
silence was particularly painful for them. The importance of self-
disclosure, of intimate sharing and acknowledgment of the past, was
evident in many survivors' reactions to this barrier. Some families
sought out and clung to fellow survivors, establishing groups, organiza-
tions, or communities based on common experiences or residence before
the war. Some survivors withdrew into their current families and used
their children as their constant, captive audiences.
Many authors have suggested that survivors' experiences interfered
with their ability for "good enough" parenting (Barocas & Barocas,
1980). Survivors have been described as emotionally unavailable, over-
protective, and using their children for their own conscious and uncon-
scious needs (Barocas & Barocas, 1973; Freyberg, 1980; Phillips, 1978;
Sigal & Rakoff, 1971). Rakoff, Sigal, and Epstein (1967) discuss how
children are expected to give meaning to their parents' lives and to
restore the lost objects, goals, and ideals of their parents. The children
are expected to become extensions of their parents, as well as symbols of
all that their parents lacked in their own lives. Many of the problems
described in children of survivors have been related to their parents'
inability to allow their children to assume individual identities.
Impairment of symbolizing processes in survivors may be related to
their parenting difficulties. Freyberg (1980) states that mothers were
frequently bewildered with their role, having lost access to their intro-
jected prototype of a good mother. Sonnenberg (1972) comments that
the ego functions necessary for parenting are lost to some extent in
every survivor. I suggest that these parenting difficulties are related to
impairments in parents' overall ability to symbolize. Those survivors
who did not maintain internalized good objects, i.e., whose capacity to
symbolize was impaired, most likely had more difficulty as parents
themselves.
The purpose of this brief outline of the role of the self-disclosure at
subsequent stages of survival is twofold. First, it is to suggest the critical'
role of acknowledgment of experience in maintaining a sense of related-
ness with oneself and one's world. Second, and directly following from
232 Arlene Cahn Gordon

the first, focusing on the difficulties of self-disclosure in the extra-

ordinary experiences of Holocaust survivors begs the question of how
one's acknowledgment of traumatic life events affects subsequent
generations.

Self-Disclosure: A Developmental Framework

The importance of examining the relationships between acknowl-

edgment of experience and relatedness within and between generations
is also based on several theoretical assumptions. Developmentally, sym-
bolizing and acknowledging one's experience is the process by which a
child is introduced to his/her world, initially in the interaction with
parents: Eventually, it is the process by which one becomes an active
participant in society. Through the process of naming experience, a
human being identifies and attributes meaning to thoughts, thereby
establishing a sense of identity. Symbolizing of experience is the means
by which one comes to understand not only oneself, but one's social
world and culture.
Consider the relationship between language, thought, and culture
within the family system. The family is the initial "culture" to which a
child is exposed. It is the world of symbols produced by the family that
introduce that family and the larger world to a child. It is also those
symbols with which the child learns to think and to communicate. Kaye
(1982) states that mind and language would not develop without the fit
between infant and adult behavior. Parents help children make their
intentions clear and make their expressions fit the conditions and re-
quirements of the "speech community" or culture. Bruner (1983) dis-
cusses the interdependence of mother and child in the development of
language. Even before a child asks a single word, language formation
begins. "Mother and infant create a predictable format of interaction that
can serve as a microcosm for communicating and for constituting a
shared reality" (p. 18). Vygotsky (1962) refines the role of social relations
as the root of mental development. Communication, he says, is the ori-
gin of the mind.
This theoretical framework suggests the tremendous influence of
the parent's communication with the child on the child's symbol forma-
tion development. Not only words themselves, but formats of interaction
between parent and child serve as the basis for the child's development
of language, thought, and communication. I suggest that variations in
the nature of parent communication contribute to the individual differ-
ences in symbolic processes and communicative ability in children.
Self-Disclosure in Holocaust Survivors 233

Referential Activity: A Measure of Self-Disclosure

Having outlined some of the hurdles to appropriate symbolization
of experience for survivors, and the importance of such symbols in the
parent-child relationship, I became interested in finding a way to empiri-
cally investigate the effects of survivors' ability to acknowledge experi-
ence on their children. I theorized that the success with which those
hurdles were overcome varied, and that that variation significantly im-
pacted upon survivors' relationship with their children as well as their
children's own symbolic processes. In other words, I proposed that sur-
vivors' ability to disclose their own experiences would affect not only
their relationship with their children and what their children know
about them, but their children's relationship with others and knowledge
of themselves.
In order to investigate the above proposition empirically, a measure
of acknowledgment of experience was needed. I have drawn extensively
from the work of Bucci (1982, 1984) and Bucci and Freedman (1978, 1981),
who have investigated the process by which individuals name their
experience. They propose a dual-code model of representing experi-
ence. One represents or codes experience verbally, in words and defini-
tions. One also represents or codes nonverbal experience, in sensory,
affective, motoric, and temporal representations. These authors intro-
duce the term referential activity to describe the process of making
symbolic links between words and inner experience. This process is the
basis of both understanding speech and speech production. In compre-
hending another person, one enters memory with a word and retrieves a
referent which is either an image or another word. In producing speech
one retrieves representations from memory and generates words. In
other words, we store our experiences in many ways, through our
senses, emotions, bodily sensations, and words. Referential activity is
the process of accessing and translating that inner experience, those
stored nonverbal, experiential representations, into words. It may be
considered as the active cognitive function involved in self-disclosure. I
am also suggesting that it is a way to measure a person's access to or
knowledge of him/herself.
These authors suggest that individuals vary to a large extent in their
ability to name their experience or find the right words. This variation is
reportedly not correlated with measures of intelligence (Bucci & Freed-
man, 1978). Two studies of referential activity helped crystallize my
investigation. First of all, the ability to acknowledge experience, referen-
tial activity level, was related to depression (Bucci & Freedman, 1981;
Bucci, 1982). Clinically depressed patients had lower referential activity
at the beginning of their hospitalization than immediately before
234 Arlene Cahn Gordon

discharge. The more depressed an individual, the less able to link expe-
rience to word. Secondly, Jaffe (1985) related mothers' referential activity
to their speech interaction with their children, which was related to the
children's separation tolerance. These studies are significant because
they relate the ability to acknowledge experience, referential compe-
tence, to two of the major difficulties discussed in relation to both sur-
vivors and children of survivors, namely depression and separation
individuation problems.
Given the results of the referential activity studies described above,
consider the following: (1) Depression evident in survivors is related to
their difficulties communicating their war experiences. (2) In children of
survivors, depression may be related to their inability to "name" their
own experience and that of their parents. (3) The prevalence of diffi-
culties with separation in children of survivors may also be associated
with difficulties in their capacity to form symbols. While depression and
separation have been studied extensively with this population, the me-
diating variable, symbol formation, has not been addressed.

The Study of Self-Disclosure in Survivors

and Their Children
The current study proposes that the ability to acknowledge one's
experience, to contain it in language, is the mediating variable between
the actual experience, in this case the Holocaust, and one's level of ad-
justment. An individual's sense of relatedness to others and to oneself is
the aspect of adjustment I focus on. Furthermore, on the basis of jaffe's
findings, I suggest that a mother and a child's ability to acknowledge
experience will be related, and this might help us to understand possi-
ble intergenerational effects of the Holocaust. We would then expect to
find a positive correlation between a survivor's ability to acknowledge
Holocaust experiences and her child's ability to acknowledge her own
experiences-acknowledgment that is considered fundamental to the
experience of self-relatedness or self-intimacy. Furthermore, we would
expect this relationship for other intense events: In this respect this
relationship in Holocaust survivors would represent a catastrophic ex-
treme intensification of a human pattern that is universally shown. The
present study was formulated to examine the relationship between
mother and daughter's acknowledgment of experience in all partici-
pants, a children of survivor and a control group, as well as to compare
the groups to determine if there was any special effect of the Holocaust
on this relationship.
Forty adult women whose mvthers were Holocaust survivors and 40
Self-Disclosure in Holocaust Survivors 235

Jewish women of American-born mothers participated in this study. The

study was restricted to mothers and daughters for statistical reasons,
given the sample size. The other three basic nuclear family relationships
need to be considered in the future. The criteria for participation, for
children of survivors, included having a mother who was either interned
by Nazis in forced labor camps or concentration camps, or who was in
hiding from the Nazis and/or participated in the underground resis-
tance. Children of survivors were recruited through second-generation
organizations and from referrals of professionals, researchers, and clini-
cians in the field. Participants ranged from 18 to 45 years of age. Half the
children of survivors in the sample were participants in such organiza-
tions and were recruited from this membership while half had not par-
ticipated in any such groups. Control women were recruited by asking
children of survivors to refer female Jewish friends who, to their knowl-
edge, were not children of survivors.
All participants were initially contacted by phone and asked if they
would be willing to take part in a study about daughters' knowledge
and communication with their mothers about their mothers' life ex-
periences. Meetings took place at the convenience of the participants,
usually in their own homes, for approximately Ph. hours. Partici-
pants completed a structured interview and two taped 5-minute
monologues.
Let me stress that I was not interviewing mothers directly: I was
determining mothers' ability to acknowledge experience based on the
administration of a structured interview to their daughters. The struc-
tured interview was designed to assess the nature of mothers' communi-
cation in two ways. Participants were asked specific facts about their
mothers' experiences, and were also asked to describe the quantity of
their mothers' communication. The first measure, number of specific
facts known about mothers' experiences, is interpreted as an indirect,
objective indicator of mothers' communication. This is based on the
assumption that a survivor mother's prewar and war experiences could
only be known by the daughter if the mother acknowledged them to
someone at some point in her life. It was not possible, or necessary, to
determine whether the information daughters knew was told to them
directly by their mothers or by other relatives, friends, or from overhear-
ing conversations. What was important, what was being measured, was
the amount of information acknowledged by the mother in some way.
The second measure, of participants' perceptions of the quantity of their
mothers' communication, is a more direct but subjective assessment of
mothers' ability to acknowledge their experiences.
These measures of mothers' acknowledgment of experience were
correlated with measures of daughters' acknowledgment of their own
236 Arlene Cahn Gordon

experience, specifically their level of referential activity. Women with

more active and direct referential connections in their verbal style, in
other words, with high referential activity levels, are seen as better able
to link verbal and nonverbal aspects of experience to words. In this
study, two monologues were used and scored for referential activity.
Participants' verbal style was measured by a monologue during which
they were asked to speak for 5 minutes about any interesting personal
life experience. This monologue was rated as to level of specificity, con-
creteness, clarity, and overall imagery level, to obtain an overall mea-
sure of referential activity. The second monologue was used to assess
participants' ability to translate their own representations of their
mothers' experiences into words. Children of survivors were asked to
speak for 5 minutes about their mothers' experiences during the war,
and controls were asked to speak about the most difficult experience of
their mothers, before they were born. This monologue was also rated
along the four dimensions of specificity, concreteness, clarity, and over-
all imagery level.
As noted, individuals vary in referential competence. All partici-
pants in this study were asked to speak about an interesting personal
life experience. Some women, for example, chose the birth of a child as
such an experience. A comparison of two excerpts on this topic shows
the wide range of expressive features related to referential activity
which are apparent in different discussions of similar events. The first
excerpt is from a woman who scored above average in referential
competence:
And uh, I'll never forget the night we went into labor, cause that day my
husband had gotten up at 5 AM to go to work, and I had gotten up with him
and never gone back to sleep. But I was reading and sewing and doing all
these last-minute things. And that morning I was on the phone with my
girlfriend, flipping through the calendar and deciding I'm not having this
baby for another 10 days. And uh, we went out to dinner, came home very
tired ... and then my water started to break, but it trickled out so you, I was
sure I was incontinent at the age of 27. It was the most horrible, horrible
feeling. And here I'd been up since 5 AM and I'm exhausted ...

In this excerpt the language is clear and rich in descriptive detail. Con-
crete examples of specific actions and feelings bring the event to life. In
contrast is a sample from a low-referential activity monologue:
Urn, let's see. Giving birth. (Chuckles.) That was a real exciting thing. That
was a traumatic experience. Urn, never expecting to go natural I went natu-
ral. That really is like number one in life experiences. Urn, you know I had a
wonderful doctor and my husband was very supportive. Urn, everything
really went smoothly even though I wanted to get uh, epidural needle and
everything, urn I was able to do it without anything. And it's been great, you
know.
Self-Disclosure in Holocaust Survivors 237

This example of low referential activity narrative is vague and full of

generalities. There are few descriptive details. It is difficult, as a listener,
to conjure up an image of this actual event. Both excerpts describe an
event of major significance in these women's lives, but the ability to
access specific, detailed, sensory, and imagistic language to describe
these events differs dramatically.
The first major finding in the study is that, as expected, there was
no significant difference between children of survivors and controls on
measures of standard referential activity level. In other words, partici-
pants' ability to acknowledge their own experiences did not differ in the
two groups. This finding upholds previous studies which stress that
children of survivors are not less "competent" or less well-functioning
than other people (Kestenberg, 1972; Klein, 1971; Phillips, 1978; Pilcz,
1979). As with the variety of symptoms discussed in the literature,
referential activity level varied in children of survivors as in other
individ uals.
Given this anticipated null finding, we then looked at the relation-
ship between referential activity and the measures of participants'
mothers' communication. For children of survivors only, there was a
significant relationship between a mother's ability to acknowledge her
Holocaust experiences and the child's ability to acknowledge her own
experiences. Specifically, the more facts children of survivors knew
about their mothers' lives before and during the war, and the more
frequent they perceived discussions about the war to be, the higher the
children of survivors' referential activity level on the five-minute mono-
logue, in which they talked about their own personal experience. This
relationship was not significant in the control group.
There was a significant relationship in all participants, however,
between their mothers' ability to acknowledge her difficult experiences,
assessed by how many facts participants knew, and daughters' refer-
ential activity in the second monologue, in which they spoke about
those difficult experiences. I will discuss the significance of this finding
further on.

Unique and Universal Implications

The central finding of this study is that survivors who are able to
acknowledge and communicate their traumatic Holocaust experiences
have children who are better able to symbolize their own experiences;
survivors who cannot talk about the Holocaust have children with more
impaired capacities to discuss experiences in their own lives. How is it
that a woman's knowledge of her mother's war experiences 40 years ago
238 Arlene Cahn Gordon

is related to her own discussion of giving birth, traveling to a foreign

country, or dealing with her boss (some of the topics discussed in chil-
dren of survivors' monologues)? I will address the significance of this
relationship in terms of the unique nature of the Holocaust and its im-
portance for the lives of children and survivors. I will also address what
I consider the more universal implications of this relationship between
symbolic processes in parents and children.
What was immediately apparent in conducting this study was that
all children of survivors know that their parents went through the Holo-
caust. Whether or not specific experiences were discussed, this knowl-
edge was "always there" for most. Thus the existence of the Holocaust as
a representation in the minds of survivors and their children remains,
regardless of the degree of clarity, specificity, concreteness, or imagery
level.
Equally apparent as a central issue in this study, is that children of
survivors want and need to know about their parents' Holocaust experi-
ences. One woman said, "I was a real snoop. I hid in closets to overhear
her talk to her cousins. Them she talked to." Prince (1985) states that the
"drive to know" about the Holocaust is a common characteristic shared
by all children of survivors. I conceptualize this "drive" as a manifesta-
tion of a general psychological tenet, that there is a tendency towards
health in all individuals. Maslow conceives of self-fulfillment as the
main theme in human life. Self-actualization is the desire to become all
that one is capable of becoming (Hjelle & Ziegler, 1976). Children's desire
to know their parents' Holocaust experiences can be understood in this
light. Children of survivors seek knowledge of their parents' experi-
ences not only for their own health, but in order to realize their full
potential.
A series of common themes emerged in children of survivors who
had difficulty acknowledging their own experiences, which were dis-
tinct from those who were better able to do so. Children of survivors
with low referential activity ratings described their mothers' discussions
about the Holocaust as infrequent or limited in some way. Some mothers
could not speak about their experiences at all. Some spoke only of posi-
tive events; negative events or feelings were denied or not fully symbol-
ized. Some mothers were ambivalent; they would talk, but made it clear
that discussions inflicted pain.
Consider the following quotes from children of survivors with low
referential activity ratings:
Sometimes I'd ask. She'd always change the subject. I knew not to discuss it.
I got a bad response. I let bygones be bygones.
I think the most important aspect of my life is that my parents are survivors.
She doesn't really talk about the war. When she speaks, she speaks about
before the war or after the war.
Self-Disclosure in Holocaust Survivors 239

My mother was able to talk freely about life after the war, but she did not
want what happened to her during the war to intrude. She never verbalized
it. It was too painful. She still denies her background has had an effect on her.
It's become pivotal to me. Not that I went seeking it. It started to intrude in
my consciousness.

We can see in these comments how important their mothers' Holocaust

experiences were even to those children of survivors who didn't hear
about them, and in spite of their mothers' attempts to keep the experi-
ences from their children. Children of survivors wanted and needed to
hear their mothers' experiences.
Children of survivors with high referential activity ratings, in gen-
eral heard a great deal. Painful feelings were not denied. The children
sought information even though it was difficult. They also appeared to
know how to regulate their questioning and listening so they did not
become overwhelmed, even though they may not have felt that they
could regulate their participation. Consider the following quote from a
woman with high referential activity scores:
I just remember them sitting at the kitchen table. My room was directly
across from the kitchen. I could look from my bed, into the room, and see the
light. The only time I think my mother would really let herself go, to all her
feelings about the war, was to my aunt. My mother and my aunt, they'd go
into great detail. I tune, I usually tune it out because it's too much for me. I
wanted to know all the details, but not all at once. And sometimes they just
talk and talk I don't know how many hours into the night. Before the war,
during the war, after ...

This woman knew how to regulate what she heard even though she felt
it was too much at times. The important factor is that the information
was accessible, if she wanted it.
In the following quote, the central thesis of this study is clearly
articulated by a child of survivors herself:
She doesn't understand why the war affects me. She was in the camps. I said
'Mom, I've heard about the war since I was a baby.' She thinks it's separate.
She doesn't understand how much little words accumulate and are your life
experience.

Children of survivors' mothers' words are their own experience. With-

out these words, part of children of survivors' own experiences are
missing.
Why? This study suggests that parents' war experiences are an
important and pervasive part of children of survivors' own experience
and as such, the clearer, the more contained, and the more differentiated
Holocaust representations are, the clearer children of survivors' other
experiences are as well. As mentioned above, the majority of children of
survivors in this study described the pervasiveness of the Holocaust in
240 Arlene Cahn Gordon

their lives. Consider these examples of how the Holocaust representa-

tions intruded on everyday events in their own lives:
Anything would trigger a discussion. A sound, a reminder. When someone
was barbecuing, my mother said that's what it smelled like in the camps.
My mother would never wear yellow. She wouldn't let me. Then she'd tell me
about the yellow armband.
My mother would go shopping early in the morning or late at night. She
couldn't stand to wait on line for food.

These examples portray specific instances of everyday life that,

through survivor mothers' communication, became colored by the Holo-
caust. It is the accumulation of these instances that forms the backdrop
of experience, resulting in many children of survivors characterizing the
Holocaust as a central factor in their own lives.
The pervasiveness of the Holocaust in children of survivors can be
further accounted for by returning to the initial culture of the child, the
facilitating environment provided by the mother. Kestenberg (1972)
states that, although the task of acknowledging one's parents' experi-
ences is important for anyone growing up, it is different for children of
survivors because it includes "a reality which defies trust in human
nature." The Holocaust shook the most basic foundation of personality-
trust. A child with a basic sense of trust sees the social world as a place
of safety and stability, and views people as nurturant and reliable
(Hjelle & Ziegler, 1976). For survivors of the Holocaust, their view of the
social world and of humanity was shattered by reality. In order to con-
tinue functioning in current reality, they must maintain a degree of trust
in everyday events, while living with the memory that every aspect of
that reality, in the past, was unsafe. In most personal tragedies, while
specific elements of the world become dangerous, one's basic foundation
remains at least manifestly stable and trustworthy, to a reasonable
degree.
The constant struggle to differentiate what is trustworthy from
what is a threat, the earliest fundamental stage in psychosocial develop-
ment, according to Erikson (1963), is viewed as a key factor accounting
for the pervasiveness of the Holocaust in the lives of survivors and their
children. In order to establish basic trust, every aspect of current life
must be differentiated from its past associations and assigned new
meaning in the shared world of the survivor and her child.
For example, when a survivor verbalizes her reaction to the color
yellow, the child learns it is the yellow armband of the Holocaust that
symbolizes evil, and not everything yellow; the significance of "yellow"
becomes contained. In contrast, when the survivor is threatened by
"yellowness," by uniforms, by a sound or a smell, and cannot make the
Self-Disclosure in Holocaust Survivors 241

connections to her past, her child in some sense "inherits" such diffuse
fears. Thus, while connections to the past pervade all current reality, the
ability to label these connections determines the extent to which the
past is contained or perpetuated.
While this process of discrimination and labeling is necessary in
every parent-child unit, I suggest that survivors have an additional
symbolic step to perform. They must in a sense relearn what is safe in
the external world and symbolize the distinction effectively, in order to
communicate to their child a sense of the world as safe. Other individ-
uals do this, to a large extent, once only as they are growing up. While
particular events may be emotionally loaded and signify aspects of their
own past that were not considered safe, for survivors it was their entire
universe.
A possible implication of this finding is that the more able an indi-
vidual is to acknowledge her experience, the less likely it is to be acted
out or to cause adjustment difficulties such as depression or separation-
individuation problems. The testing out of this inference would be a
logical next step for research.
What are the more universal implications of the relationships found
in this study? I'd like to return to the significant relationship found in all
participants between referential activity based on the second mono-
logue and number of facts known about mothers' difficult experiences.
It may not be surprising that the more specific facts participants knew
about their mothers' terrible experiences the more specific and clear they
could describe the event. This finding might be explained simply as a
function of memory; the more facts children heard, the more facts they
can tell. The relationship between knowledge of facts and the expres-
siveness and evocativeness of their description is more difficult to ex-
plain in such direct terms. Based on what is known about referential
activity, what appears to be measured in this case is what these women
have internalized and symbolized of their mothers' experiences in verbal
and nonverbal representations of their own.
Consider the following excerpt from a child of survivors' monologue
about her mothers' experiences symbolized in a dream which her
mother had told her:
One day, one night I should say, she had a dream. And she dreamt that she
was back in Tarnigov; which was a very happy place for her. You know, she
loved that town. And she dreamt that, um, she walked into the center of the
town, and she saw her father. And she ran to him and she said, "Papa, Papa,
aren't you happy to see me?" And he said, "Yes, yes an-butIwanna tell you
that the, you know, the linens are here and the silver is there, and this, these
valuables I put here for you." And then he started walking away. And she
said, "Where are you going? Aren't you-I just got home. Aren't you happy
to see me?" And he said, "Yes, but you must listen very carefully." And he
242 Arlene Cahn Gordon

just went on and on and on. And then he went into a house and started
walking up the stairs. And she said, "Where are you going?" And she ran,
tried to go up the stairs behind him. And he said, "No, no, no, you can't come
with me now." And he went up the stairs and disappeared. And she said that
she woke up screaming. That she was so frightened by this dream that she
couldn't even tell anybody about it. ..
This woman with high referential activity describes her mother's
dream with a sense of immediacy because, in a sense, the experience is
"alive" within her. It may not even be an accurate summary of what she
was told. It is now her memory of her mother's experiences in multi-
layered symbolic form.
Of importance for this discussion is that referential-activity scores
from these monologues about parent experiences were correlated with
specific facts known in all participants. While the correlation was greater
for children of survivors, the important finding with this monologue
was that there was a significant relationship between referential activity
and mothers' communication factors in both groups. By this relation-
ship, the study recognizes a more general phenomenon, that is so clear
in the survivor population-and that is that parental acknowledgment
of one's own experience is related to one's children's symbolic ability.
Confirmation of the generalizability of this study will come through
further research. This study has implications for children of survivors of
other large-scale, man-made disasters as well as more general human
interaction. Lifton (1968) has compared personality traits in children of
Hiroshima survivors to children of Holocaust survivors. The transmis-
sion of symbolic impairment may also be evident in such devastating
disasters. In addition, this research may have implications for children
whose parents have experienced physical or psychological trauma, ill-
ness, or loss of various types. The development of groups of children of
alcoholics and children of the chronically ill, like children of survivor
groups, suggest the general importance, for one's own health, of label-
ing parental trauma. Eventually, with more sensitive instruments, it
may be possible to identify the symbolic transmission processes of more
universal life-crisis issues on children's symbolic activity. This study did
not tap the process of acknowledgment of specific traumas and the con-
sequences of a failure to do so. While I suggest that this process is in
many ways unique in children of Holocaust survivors, there is also
overlap with other personal traumas and cultural disasters, and this
needs to be studied.

Therapeutic Implications
What are the implications of these findings for the treatment of
Holocaust survivors and their children? Children of survivors need to
Self-Disclosure in Holocaust Survivors 243

acknowledge their parents' Holocaust experiences in order to develop

the capacity to acknowledge their own. Yet for many, their needs have
been frustrated by their parents' limitations. In order to prevent a kind
of intergenerational transmission of the failure to acknowledge painful
experiences, therapists must provide the environment in which the Ho-
locaust experience can be brought out, and not contribute to the referen-
tial activity failure by their own countertransference reactions and
resis tances.
Even where survivors are unable to label their experiences, children
of survivors nevertheless maintain nonverbal internalized representa-
tions of the Holocaust as this study has shown. Thus, they can be helped
to link their own images and words, even if they do not have access to
their parents' words. The therapeutic process can repair, for children of
survivors, the paradoxical not knowing that which they have always
known. This is a central function of the therapeutic process in general;
this is its power. For a child of Holocaust survivors, this process must
include symbolizing one's parents' Holocaust experiences in the process
of acknowledging one's own history as well as one's current reality.

Conclusion
Self-disclosure occurs in a social context; it is fundamental to the
experience of relatedness with others and ultimately with oneself. This
study began with a theoretically based assumption, that one's ability to
acknowledge experience is acquired in a relationship with one's parents.
It concludes, based on empirical data, that a child's ability to acknowl-
edge experience is affected by the parents' ability to do so. I am thus
suggesting a powerful intergenerational connection between self-dis-
closure and relatedness. This connection may account for a continuous
ripple effect of traumatic experiences on subsequent generations. It is
also the connection that allows for the eventual containment of the ef-
fects of traumatic events. Self-disclosure within a relationship, be it with
parent, child, friend, or therapist, allows one to extend and enhance the
fabric of life woven by previous generations.

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 16
From Secrecy to Self-Disclosure
HEALING THE SCARS OF INCEST

Mary Gail Frawley

Sexual abuse of children is a phenomenon that has only recently

emerged from society's skeleton closet as a topic to be discussed and
researched. Incidence figures generated by two large random sample
epidemiological studies indicate, however, that approximately 38.0% of
all women have been sexually abused before the age of 18, with about
4.5% having been sexually victimized by a biological, adoptive, step-, or
foster father (Russell, 1986; Wyatt, 1985). The sexual violation of her
physical and emotional integrity by a father figure thus appears to be an
experience common to over 3.3 million American women. It is an experi-
ence grounded in secrecy; secrecy imposed by the perpetrator with
promises and threats ranging from the gently insidious to the brutally
forceful. It is an experience out of which arises a plethora of negative
psychological sequelae, including an impaired capacity for emotional
and sexual intimacy. Finally, it is an experience the healing of which
often begins with the survivor's self-disclosure.
A review of book titles on childhood sexual abuse reflects the cen-
tral role secrecy plays in this experience: Conspiracy of Silence: The Trauma
of Incest (Butler, 1978), I Never Told Anyone (Bass & Thornton, 1983), The
Common Secret (Kempe & Kempe, 1984), The Family Secret (Hill, 1985), The
Best-Kept Secret (Rush, 1980), The Secret Trauma (Russell, 1986), No More
Secrets (Adams & Fay, 1981). Secrecy is the cornerstone of incest and is

Mary Gail Frawley. Pomona Clinic, Robert L. Yeager Health Complex, Pomona, New
York 10970. The author thanks Michelle Collins, Michael O'Toole, and Ann Kuehner for
their review of this manuscript and for their valuable editorial suggestions.

247
248 Mary Gail Frawley

imposed by the abusing father with a variety of intimidations, some of

which are poignantly captured by Charles Summit in his 1983 article,
The Child Abuse Accommodation Syndrome:
This is our secret; nobody else will understand ... Don't tell your mother-
she will hate you; she will hate me; she will kill you; she will kill me; it will kill
her; she will sen,j you away; she will send me away; it will break up the family
and you'll end up in an orphanage ... If you tell anyone, I won't love you
anymore; no one will love you; I'll spank you; I'll kill your dog; I'll kill you.
(p. 181)

The imposition of secrecy is usually effected with such success that

the incestuously abused child often reaches adulthood with the incest
secret intact. At the more extreme levels of preservation, the incest may
remain repressed within the unconscious of the survivor, thus constitut-
ing a secret even from the victim herself or, in multiple personality, may
be contained within a separately functioning personality who has only
marginal interaction with the birth personality. If, on the other hand, the
child does disclose while the incest is occurring, she may be disbe-
lieved, vilified, or ignored, rather than validated and supported.
The pervasiveness of secrecy was evident in the author's study of 82
survivors of father-daughter incest (Frawley, 1988). Results indicated
that 56.0% of the women did not disclose their incest until adulthood;
the mean age of adult disclosure was over 29 years. Of the 36 women
who did disclose while the incest was happening, 78.0% failed to re-
ceive any support from the disclosure target. For the majority of father-
daughter incest victims, then, their victimizations become actual and
internalized core developmental experiences that are relegated to the
shadows of secrecy; key aspects of their lives that are rendered unknow-
able by and unshareable with others or sometimes even themselves. The
intense affects attached to the incest memories, and the isolation in
which both become enshrouded, alienate the child/women from an en-
tire realm of her development, resulting in deficits in her sense of re-
latedness to self and others.
The long-term negative sequelae of father..:..daughter incest are nu-
merous and may seriously interfere with the survivor's adult function-
ing. Table 1 illustrates negative effects perceived by 82 father-daughter
incest survivors to be connected to their childhood abuse (Frawley,
1988). Other symptoms frequently mentioned in the incest literature
include promiscuity, prostitution, somatic complaints, chronic anxiety,
impulsivity, eating disorders, and increased risk of incestuous abuse of
the survivor's own children. Most of these symptoms can be concep-
tualized as reflective of impairments in the woman's ability to relate
intimately and empathically to herself and others. These relational
capacities are diminished by domination of internalized bad objects
Self-Disclosure among Incest Survivors 249

Table 1. Incest Survivors: Perceived Negative

Effects of Incest, N = 82
Variable name Percentage
Low self-esteem 95.1
Difficulty trusting men 86.6
Chronic guilt 82.9
Major depression 81.7
Sexual dysfunction 76.8
Difficulty trusting women 58.5
At least one suicide attempt 53.7
Drug or alcohol abuse 47.6
Parenting difficulties 45.1
Sexual abuse by person other than father figure 42.7
Adolescent running away 31. 7
Adult rape 26.8
Adult physical abuse 26.8
Adolescent pregnancy 20.7

(Fairbairn, 1943) and by representations of interactions with others that

have been generalized (Stern, 1985) to form templates of relational ex-
pectations regarding self, others, and self-in-relation-with-others.
It is perhaps in the area of sexual functioning that the incest sur-
vivor's impaired capacity for interpersonal intimacy is most clearly evi-
denced. David Scharff (1982) postulates that sex is a physical interaction
in the real world which links each person with his/her internal objects
and is thus influenced by the quality of the child's object relationships
from birth onward (p. 9). Scharff thus implies that sexual functioning
reflects a capacity for emotional intimacy with self and other that is
founded on early relationships with both parents. Similarly, Fairbairn
(1941) asserts that mature genitality emerges from a libidinal attitude
toward self and other that is based on early object relationships. In
healthy development, these childhood relationships engender a capac-
ity to merge temporarily with another while retaining a sense of per-
sonal separateness, a capacity reminiscent of Erickson's (1980) stage of
Intimacy and Distantiation versus Self-Absorption.
The incestuous family clearly mitigates against development of the
relational capacity necessary for functional and pleasurable sexual inti-
macy. Instead, as indicated by Scharff, the father's assault on his daugh-
ter's bodily integrity, his betrayal of the parental bond, and the mother's
failure to protect the child are parenting deficits which result in the
adult survivors' inability to "let down their own massive bodily shield to
allow appropriate penetration physically or emotionally ..." (p. 82). It is
more encompassing to view that shield as both bodily and psychic.
250 Mary Gail Frawley

The author's dissertation research was designed to study sexual

functioning among adult survivors of father-daughter incest (Frawley,
1988). Sexual functioning was conceptualized as emanating from a ca-
pacity for emotional intimacy reflective of childhood relationships with
both parents. Eighty-two incest survivors ,participated in the research
and comprised the largest sample of former incest victims to have been
studied at that time. They were compared on a number of measures of
sexual functioning with 76 control women who had no history of child-
hood sexual or physical abuse. Results indicated that the incest sur-
vivors experienced physiologically manifested sexual dysfunctions to a
significantly greater degree or significantly more frequently than con-
trol women. The survivors were also significantly more likely to ex-
perience guilt regarding sexual matters and activities, and reported
significantly less satisfaction with the quality of their current sex lives.
While all women in the study experienced greater sexual dysfunction in
more emotionally laden relationships-with husbands or with lovers for
whom there were deep emotional feelings-than in casual relationships,
the incest survivors were incrementally more dysfunctional than con-
trols in the emotionally closer dyadic contexts. Significance for these
results was achieved at least at the p<.01level. These results generally
support other empirical investigations of sexual dysfunction among in-
cest survivors (Becker & Skinner, 1983; Becker, Skinner, Abel, & Treacy,
1982; Finkelhor, 1984; Fromuth, 1986; Gold, 1986; Jehu, Gazan, &
Klassen, 1985; Landis et al., 1970; Meiselman, 1980; Van Buskirk & Cole,
1983).
Personal accounts by adult incest survivors (Allen, 1980; Arm-
strong, 1978; Bass & Thornton, 1983; Ward, 1985) and reports from clini-
cians working with former incest victims (Banmen, 1982; Cohen, 1983;
Forward & Buck, 1978; Gelinas, 1983; Gordy, 1983; Kaufman, Peck, &
Tagiuri, 1954; Kempe & Kempe, 1984; McGuire & Wagner, 1978; O'Hare
& Taylor, 1983; Renvoize, 1982; Rosenfeld, Nadelson, Krieger, & Back-
man, 1979; Ward, 1985; Westerlund, 1983) also support a connection
between childhood incestuous abuse and adult sexual dysfunction.
Charlotte Vale Allen (1980), an incest survivor, describes her experience
of sex as follows: "It was a matter of accommodating a tremendous,
invading weight while my head traveled through stage after stage of
recoil and shock and 'I tried to convince myself that I was a grown
woman doing what grown women do" (p. 225). Another survivor, a
participant in the author's study, wrote: "I feel that the worst result of
incest for me was sexual dysfunction-it was what brought me to psy-
chotherapy ... I simply could not continue pretending to enjoy it one
more minute after so many years of trying, trying, trying" (Frawley,
1988). To reframe the struggle, these women were engaged in a losing
Self-Disclosure among Incest Survivors 251

battle to construct a mutually safe, empowering relationship that com-

bined emotional and sexual intimacy.
If secrecy is the mainstay of father-daughter incest, and if an im-
paired capacity for emotional and sexual intimacy is one of the tragic
long-term consequences of childhood incestuous abuse, it can be postu-
lated that disclosure of the incest secret to a validating, believing other
may begin a process of healing that can reopen channels of intimate
relatedness to self and other. Before discussing the effects of disclosure,
however, it is important to remark on the ways in which disclosure can
be elicited by clinicians.
Many women with incest in their pasts have "completed" one or
more psychotherapies without ever having mentioned their sexual
abuse (Courtois, 1980; Faria & Belohavek, 1984). In some cases, these
women may have been desperately hoping just to be asked so that they
might begin to speak (Herman, 1981; James, 1977, in Swanson & Biag-
gio, 1985). It is crucial, therefore, that clinicians ask about sexual abuse
during every intake. In one study conducted by Briere and Zaidi (1988),
100 intake reports on nonpsychotic women presenting to an urban psy-
chiatric emergency room were reviewed in two phases. In the first re-
view, 50 charts were randomly selected and the intake report was
checked for a history of sexual abuse; 6.0% of the charts reflected such
data. Clinicians were then instructed to question intake patients for
previous sexual victimizations. Another 50 postinstruction intake re-
ports were randomly reviewed and, this time, researchers found that
70.0% of the women interviewed reported having been sexually abused
at some point in their lives. Not surprisingly, an incest survivor who has
carried her secret into adulthood may not be able to disclose unless she
feels certain that the therapist believes that childhood sexual abuse oc-
curs and that he/she can tolerate hearing the woman's story. The clini-
cian who asks about past sexual victimizations during intake conveys to
the patient that she/he does know and believes that children are sexually
abused, that those victimizations are important clinical material, and
that he/she is prepared to join with the former victim in working
through the memories and affects linked with any childhood abuse.
Many other women may enter treatment with their sexually abusive
experiences repressed. In these cases, the therapist's knowledge of and
attention to the signs and symptoms of sexual abuse may allow her/him
to help the patient unlock repressed memories, thus facilitating working
through and recovery. Courtois (1988), Ellenson (1986), and Gelinas
(1983) fully discuss presenting and historic characteristics that alert the
therapist to possible childhood sexual abuse.
Once psychotherapy begins with an incest survivor, the work may
evoke strong affective responses in the clinician. The material regarding
252 Mary Gail Frawley

specifics of the abuse may, for instance, engender powerful feelings of

anger-at the perpetrator, the nonabusing parent, and toward the vic-
tim, revulsion, fear, eroticism, a wish to rescue, a wish to avoid. Addi-
tionally, for the therapist/survivor, this work may evoke particularly
potent memories and feelings related to her own abuse. It is thus impor-
tant, as Courtois (1988) and Herman (1981) indicate, that therapists treat-
ing incestuously abused women carefully work through their attitudes
and affects towards childhood sexual victimization in general, and any
abuse in their own pasts in particular, to ensure that they can provide
service to the incest survivor that encourages continued disclosure and
discussion.
Finally, these patients often present with characterological disorga-
nization and defenses likely to evoke strong positive and negative coun-
tertransferential reactions not necessarily directly linked to the incest
material. As Fairbairn (1943) and Scharff (1982) discuss, the betrayal of
trust inherent in incest and the confusion bestowed on the child by
having to adapt to the invasion of her physical and psychic boundaries
by a loved and needed parent often results in severe splitting of the ego.
This once-adaptive survival mechanism can lead to the discontinuous
self and other representations and to the defensive constellation consis-
tent with borderline personality structure as described by Kernberg
(1984). The clinician's own ability to sustain an openness toward inti-
mate relatedness within appropriate therapeutic boundaries throughout
the Sturm und Drang of treatment with an incest survivor organized at
the borderline level of ego structure will certainly be associated with the
patient's progress in increasing her own capacity for intimate related-
ness. Implied support for this view is contained in articles by Epstein
(1979), Gorney (1979), and Racker (1972) in which they discuss trans-
ference/countertransference and the interpersonal context of psycho-
analytic work. .
Before discussing the considerable positive effects of disclosure on
an incest survivor's overall functioning and capacity for intimate related-
ness, it is important to note that disclosure of the incest secret may
initially engender increased disorganization and symptom exacerbation
(Courtois, 1988; Gelinas, 1983; Herman, 1981). Gelinas indicates that
revealing an incest history may release a flood of painful memories and
affects connected to the original trauma. She points out that women
may, during this initial stage of treatment, experience disorganizing
flashbacks and/or reenact some portion of their abuse. Similarly,
Courtois asserts that self-punitive behavior may be evoked by the be-
trayal of and disloyalty to the family represented by the very act of
disclosure. These after-effects of disclosure can be postulated to reflect
the return of repressed bad objects (Fairbairn, 1943) to whom the incest
Self-Disclosure among Incest Survivors 253

survivor remains unconsciously and tenaciously attached. A group at

greater risk for suicide than women without histories of sexual victimiz-
ation (Bagley & Ramsey, 1985; Briere & Runtz, 1986), incest survivors
may attempt or complete suicide when disclosure evokes very painful
and/or very rageful previously repressed feelings about their abuse
(Courtois, 1988). Attempted or successful suicides can, in these cases,
be viewed as vicious attacks on and by the woman's parental introjects.
Simone, an attractive 36-year-old incest survivor, had disclosed her
incest for the first time when she came to therapy around problems in
her seven-year, childless marriage. At intake, Simone stated that she
had unresolved feelings about her childhood incestuous abuse and
about her father, who had suicided 15 years earlier. In addition to the
sexual abuse, Simone had been terribly neglected as an infant by both
parents-left alone in a crib for hours while they drank at a neighbor's
house-and was verbally denigrated by her mother into adulthood.
It became clear early in Simone's therapy that she was truly "pos-
sessed" by punitive introjects (Fairbairn, 1943) who deemed her useless
and a totally unworthy being. Gradually, the therapy itself became an
instrument of self-torture as Simone ruminated virtually nonstop about
her sessions, her memories of her traumatic childhood, and her feelings
about those memories. Rage was one emotion Simone expressed during
the last weeks of her therapy; rage towards her mother for not protecting
her and towards herself for "letting" the abuse happen, as well as for not
working "hard enough" in her therapy. She also expressed anger and
disappointment toward the author for the latter's inability to read Si-
mone's mind; for not simply intuiting all that Simone had difficulty
disclosing herself. While suicidal and homicidal ideation were ex-
pressed, intent and a concrete plan were denied. Despite her dis-
claimers, Simone suicided four months after beginning treatment,
overdosing with Seconal, as her father had done. Later, it became evi-
dent that while Simone had been open about her incestuous abuse,
there was much about her that remained secret. In particular, Simone
hid her intention to die. She never mentioned that she kept a large
supply of Seconal in her bedside night table, or that she was quietly
saying good-bye to family and friends for a month prior to her death.
Simone's suicide can certainly be conceptualized as a rageful act
against and by her parental introjects. It may have also been a desperate
act of loyal attachment to her internalized father or, conversely, an enact-
ment of a threatened punishment for disclosure. It was simultaneously
an expression of rageful hatefulness and despairing hopelessness to-
ward family, friends, and therapist. Ultimately, however, Simone re-
mained unknowable and unreachable, isolated with her horrific
internalized object world, unable to use treatment to reopen pathways
to ameliorative intimate relatedness with another.
254 Mary Gail Frawley

Despite the turbulence, and even tragedy, that may follow a sur-
vivor's initial disclosure of her incest, the opportunity to reveal the
secret and to discuss her abusive experiences with another more usually
signals the beginning of recovery from the incest trauma for many for-
mer victims (Brunngraber, 1986; Courtois, 1988; Herman, 1981; West-
erlund, 1983).
Since, by definition, women who have not disclosed their incest
secret are unavailable to researchers, it is difficult empirically to validate
the importance of disclosure. In the author's study (Frawley, 1988), how-
ever, a significant correlation was found between the age at which a
woman first disclosed her incest and several measures of adult sexual
functioning, with disclosure later in life related to more frequent or
more severe sexual dysfunction. Significance was achieved at least at the
p<.05Ievel. These results are consistent with Brunngraber's (1986) find-
ings, generated in a study of 21 adult incest survivors, that disclosing
their incest experiences to others was considered by the women to be
positively related to overall adjustment to their past victimization. Sim-
ilarly, Courtois (1980) found that all 30 adult survivors of childhood
sexual abuse that she interviewed deemed participation in her research
helpful. They specifically cited the importance of the catharsis involved
in discussing their experiences with a nonjudgmental other. These find-
ings indeed suggest that an incest survivor's self-disclosure is crucial to
reopening intra- and interpersonal channels to intimate relatedness.
Beyond findings like these, it is in clinical work with incest survivors
that the central role of disclosure in revitalizing a capacity for intimacy is
most evident.
Various books and articles discuss individual and group treatment
strategies for wmk with incest survivors (Blake-White & Kline, 1985;
Courtois, 1988; Faria & Belohavek, 1984; Forward & Buck, 1978; Gordy,
1983; Herman, 1981; McGuire & Wagner, 1978). While, to the author's
knowledge, there have been no systematically conducted outcome
studies on the retrospective treatment of father-daughter incest, a num-
ber of writers concur that many of the long-term negative sequelae of
incest are amenable to treatment through psychotherapy.
In the author's own clinical experience, several incest survivors have
demonstrated marked improvement in their capacity for intimate re-
latedness subsequent to disclosing their incest histories. Angelina, for
instance, is a 40-year-old woman who had not disclosed her incest secret
until beginning psychotherapy for anxiety and depression following the
end of her 16-year marriage. During that marriage, Angelina experi-
enced chronic vaginismus-involuntary contraction of the vaginal mus-
cles that prevents penetration. It was also clear that the lack of sexual
intimacy between Angelina and her husband paralleled an emotional
Self-Disclosure among Incest Survivors 255

distance in which they shared few aspects of their internal worlds,

relating primarily around the concrete events in their mostly separately
organized lives. Although she clearly recalled her father's incestuous
abuse, this woman did not connect her sexual dysfunction nor her emo-
tional distance from her husband with her childhood experiences. After
a year and a half of psychoanalytic psychotherapy in which her incest
and her relationship with both parents have been primary foci, An-
gelina has established a more mutually enriching relationship with a
man in which emotional and sexual intimacy are both possible and
enjoyable. Although sexual intercourse can sometimes be unsettling for
Angelina, she has had no recurrence of vaginismus since revealing her
incest history in treatment.
A dramatic instance of the ameliorative impact of disclosure is rep-
resented by the author's work with Betsey, a 38-year-old mother of three.
Betsey presented for outpatient therapy subsequent to a brief psychi-
atric hospitalization precipitated by a drunken rampage in her boy-
friend's apartment that was perpetrated while she was there alone.
Three months prior to the hospitalization, she had impulsively left her
husband of 15 years and their three children to live with a new man. The
rampage was connected to overwhelming feelings of confusion and
guilt over this behavior which stood in sharp contrast to her historical
presentation as a "good girl." At intake, Betsey reported a two-year
history of bulimia nervosa then in remission, a six-month habit of
episodic, solitary alcohol abuse, and even more recent episodic self-
mutilation during which Betsey would cut her forearms with a razor.
Childhood sexual abuse was denied at intake.
Over the first six months of treatment, Betsey cut her arms, or at
least wanted very much to cut herself, as often as once a week. It became
clear that the cutting often followed a session during which the author
failed sufficiently to validate Betsey's "badness." While this woman seri-
ously distorted the extent and depth of her badness, her behavior to-
ward her family had, in fact, been destructive. As the author learned
verbally to validate that destructiveness, Betsey could begin also to ex-
amine the pain and hopelessness that led to the behavior she so hated.
Acknowledging the truth of her malevolence thus created a holding
environment for Betsey in which she was freed to begin to integrate
more worthy parts of herself. At this point, the cutting diminished but
did not abate entirely.
During this time, Betsey also frequently dissociated in session,
without exception after she had been discussing her father in some
context. The part of her "floating on the ceiling" would report that the
part of her sitting in the chair was numb from the waist down and that
"someone" was pushing down on her head and shoulders. The dis socia-
256 Mary Gail Frawley

tive episodes, combined with other aspects of her history and symp-
toms, strongly suggested that this woman was a father-daughter incest
survivor who had repressed the memories of her abuse.
After about six months of therapy during which the author would
occasionally question Betsey about possible childhood sexual experi-
ences, Betsey had a dissociative experience at home with her boyfriend
during which she reenacted her father's pushing her to her knees to
perform oral sex on him. During this episode, she revealed to her boy-
friend that her father had threatened to cut her arms off if she ever told
about the abuse. The self-mutilation was clearly an enactment of the
threatened punishment and was evoked as her memories of the abuse
neared consciousness through the therapy.
Since Betsey reenacted her abuse, she has gradually recovered more
memories and can now tolerate remembering without dissociating.
There has been no self-mutilation since that time, and Betsey now says,
"I wouldn't even want to cut myself. It never hurt before but I know it
would hurt me to do it now." While she still has much work to do in
therapy, Betsey has begun to develop a more compassionate attitude
toward herself and she is beginning to repair the relationships with her
children. Within the therapy, Betsey's eye contact has markedly in-
creased and there is an emerging interest in the therapist as a person
rather than as someone who is simply fulfilling a professional role.
Betsey was once unable to walk down the hall with the author to her
office because it made her "too nervous" to be that close to and some-
what out of role with the therapist. Recently, however, she loped down
the hall alongside the author chatting animatedly about a newspaper
article she had read that day. It is quite apparent that, in Betsey's case,
regaining the memories of her childhood incest and discussing them
with another human being has improved this woman's capacity for inti-
mately knowing and relating to herself and others.
Many clinicians who treat incest survivors recommend group ther-
apy as a primary or important ancillary treatment modality (Courtois,
1988; Gordy, 1983; Herman, 1981; Westerlund, 1983). Group therapy af-
fords the former incest victim the opportunity to expand her disclosure
network; to reality-test negative self-concepts with women who share
similar traumatic histories; and to develop within the holding environ-
ment of the group more intimate relatedness with self, other, and self-in-
relation-wi th -other.
A survivor group run by the author confirms the recommendation
of others in the field; the group experience seems to stimulate increased
trust in self and other, in part through expanded self-disclosure in an
environment of safety and common ground. In this group of women
ranging in age from 20 to 50, it has been particularly poignant to ob-
Self-Disclosure among Incest Survivors 257

serve the "re-mothering" and "re-daughtering" taking place within the

group. Most of the mothers in the group regret what they perceive as an
inability on their part to relate empathically to their own children when
the latter were young; relationships with girl children with whom the
survivors identified were often especially distant and strained. The
women in the group who are not parents have hungered for freely given
maternal nurturance all their lives and have raged in silence against
their own mothers who were not able to provide that kind of relation-
ship. The "mothers'" need to give without damaging and the "daugh-
ters'" need both to rage and to receive have been voiced within the
group. This experience is reparative for the "mothers" who can now re-
mother themselves while responding to the "daughters" with nurtur-
ance and acceptance of their rage. At the same time, the "daughters"
have an opportunity to repair their relationships with their internalized
mothers by introjecting new maternal experiences. For all these women,
the group provides expanded channels for intimate relatedness.
Father-daughter incest is a damaging, core developmental experi-
ence which, although it occurs in childhood or adolescence, continues
to haunt the survivor's adulthood, precluding intimate relatedness with
self and other. It is an experience often secretly stored in the skeleton
closet of the adult survivor's psyche. Disclosure of that secret to an
accepting, believing other may signify initiation of a healing process.
Often long and painful, the healing begun with disclosure can ulti-
mately result in a revitalized capacity for intimacy, for knowing and
being known by self and other.

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 17
Issues in the Disclosure of
Perinatal Death
Douglas J. Peddicord

In late 1978 a son was born to my wife and me. Thirteen weeks prema-
ture and weighing just under two pounds, he died, after struggling
courageously for 11 days, on Christmas Eve. The events of his birth, life,
and death changed things-my sense of myself, my understanding of
the world, my feelings about life-to an extent that is difficult to convey
even now. And at the time very few people seemed willing to see, to
acknowledge, to understand that.
For me, part of the process of working-through involved the dictum
that one becomes expert in what one must. Nearly two and a half years
of research then, which included in-depth interviews with 35 parents
(20 mothers, 15 fathers) who had suffered a stillbirth or infant death
within the preceding 4-10 weeks, produced a dissertation (Peddicord,
1982) and a clinical familiarity with an experience that forces individuals
to make contact with what Stricker and Fisher in their Preface call "the
dark, fearful, and often untouched areas within ...."

The Problem of Perinatal Death

In modern society there is a common belief that the successful birth
of a child is a most "natural" and uncomplicated process, and that the
loss of an infant-to miscarriage or stillbirth or neonatal death-is an

Douglas J. Peddicord • 9402 Sunfall Court, Columbia, Maryland 21046.

261
262 Douglas J. Peddicord

uncommon experience. Despite the fact that more deaths occur in the
first few days of life than in any subsequent period of childhood, such
an event seems nearly unthinkable, an affront to the spectacular ad-
vances of medical technology and treatment in this century. But, in
reality, depending upon the definition of perinatal mortality utilized,
(ranging from a generally accepted time frame between the 20th week of
gestation and the 28th day of life to much broader limits, such as from
conception to one year after birth), these "rare" tragedies actually occur
from 70,000 to 250,000 times each year in the United States alone.
Though a great many mothers and fathers are forced to confront one
of the truly nightmarish anxieties of parenthood, until quite recently
researchers and clinicians largely shied away from the topic of perinatal
death. Thus, as late as 1970, Kennell, Slyter, and Klaus, while noting
detailed descriptions of mourning responses of adults to the loss of a
spouse, parent, friend, or terminally ill child, could state that theirs was
the first report in English on the reactions of parents to the loss of a
newborn. The taboo nature of the subject and dearth of research al-
lowed for caregiver assumptions marked by avoidance and denial:
Not too many years ago it was common practice for the physician of a mother
who just had a stillbirth to deny her physical contact with the dead baby's
body, prescribe tranquilizers to minimize her grief, and recommend forget-
ting about the sad event as soon as possible, perhaps by quickly attempting
another pregnancy. (Leon, 1987, p. 186)
Rando (1986) asserts that the loss of a child is unlike any other, that
parental grief is especially severe, often complicated and long lasting,
and marked by major symptom fluctuations over time. Lippman and
Carlson (1977) state: "Throughout the literature is the pervasive theme of
loss, of feeling devastated, and of the need to find the means to meet and
overcome these traumatic experiences" (p. 171). Investigators agree that
mothers (and fathers, in general) mourn and that this is usually mani-
fested in an acute grief reaction, as delineated initially by Lindemann
(1944). On occasion, marked pathological reactions such as severe de-
pression, reactive psychosis, and significant somatic difficulties have
been noted (Cullberg, 1971). Feelings of guilt and lowered self-esteem in
the mothers of deceased infants have been cited frequently (Benfield,
Leib, & Reuter, 1976; Peppers & Knapp, 1980; Miles & Demi, 1986).

Unique Characteristics of Perinatal Death

A number of authors have commented that the loss of an infant is as
much a loss of potential as a loss of a real object; instead of the fulfill-
ment of a happy expectation there is a substitution of death. And this is
a "special kind" of death. As one father put it:
Perinatal Death 263

What upsets me most is the unfulfilled potential of that child ... like that it
wasn't a real person. It's almost like if we could not have children and always
wanted one-it's that same sort of unfulfilled potential that is the saddest
thing to me, provokes the most in me. And at the same time the little being
that was and now isn't, isn't and it's ... there is nothing to remember really.
Like with a funeral people can get together and talk about the good times
they had (with the person) but for us there really weren't any good times to
be talked about. (Peddicord, 1982, p. 89)

It is a unique situation to have in some way intimately known the person

one has lost (a feeling especially true for mothers), while in another way
not to have known him or her at all. Parents often feel isolated by the
"emptiness" of the relationship with the dead infant, cut off from com-
municating with others because their "memories" are largely unfulfilled
fantasies and hopes-and, as we shall see, there is little encouragement
to share the reality of what one mother called "the overwhelming sad-
ness of leaving the hospital no longer pregnant but without a baby"
(Peddicord, 1982, p. 88).
Mazor (1970) points out that the wish to have children contains
mixed motivations: a desire to share and experience love in a new way, to
create a family, to attain an identity as generator and nurturer, on the one
hand; and attempts at narcissistic gain such as the fantasy of being
reborn, creating an extension of or better version of oneself, insuring
against loneliness, on the other. Because parents experience not only the
loss of a child or potential child but also secondary losses of hoped-for
changes in their own identities, special difficulties in mourning occur.
(In brief, the processes of mourning, as explicated in the psychoanalytic
literature, include: withdrawal of libidinal energy from the object; loos-
ening of cathexes or ties to the object; benign identification with and
introjection of the object; and freeing of the ego and a resumption of
normal functioning.) According to Furman (1976):
In mourning an infant a parent faces a particularly difficult task because (1)
he can only utilize the painful long process of detachment, since identifica-
tion would not prove adaptive (how can a parent become part child again?)
and (2) he deals not only with the loss of a loved one but also with a loss of a
part of himself (parental attachment consists of a mixture of object love and
self-love) ... The child has not yet become a person to be loved in his own
right, and his death represents primarily a loss of self and of self-esteem to
the parent. The inner adaptation to such a loss differs from mourning the
death of one who has been known and loved as a unique individual. (p. 234)
If parents who suffer a perinatal death must deal with the unusual
loss of a potential rather than an established relationship and the diffi-
culties of mourning both the lost child and their own narcissistic inju-
ries, they do so in a social context that Rando (1986) characterizes as
"uniquely strange and callous" (p. 38). She says:
Other parents are clearly made anxious by bereaved parents as they recog-
264 Douglas J. Peddicord

nize that this unnatural event could happen to them and their own children.
Bereaved parents represent the worst fears of these other parents and they
become the victims of social ostracism and unrealistic expectations as other
parents attempt to ward off the terror generated within them ... It is common
for bereaved parents to experience feelings of abandonment, helplessness,
and frustration as reactions to their experiences with other parents. They
often complain that they feel like "social lepers." (p. 38)

Peppers and Knapp (1980) explain:

The unusual character of the grief response in relation to infant loss is also
determined by ... the way infant death is defined and perceived in our cul-
ture. The community-friends, neighbors, and even relatives-neither per-
ceives, nor responds to, infant death in the same way as it does to the deaths
of older, loved persons. The community tends to disregard the infant as a
real, living person, and thus to disassociate "normal grief" in response to the
loss of an older person from "pseudogrief" in response to infant loss. The
death of an infant is defined not so much as a "tragic" occurrence for the
family as simply an "unfortunate" one. Consequently, the community ex-
pects the mother's reaction to this "unfortunate" event to be short-lived and
temporary. (p. 28)

A central characteristic of parents' experience is that their loss is not

validated, and this becomes a primary impediment for mothers and
fathers to disclose genuinely to others the fierce anguish they suffer.

The Impact on Parents

In the author's formal research, in addition to clinical interviews,
two paper-and-pencil measures have been utilized to assess the experi-
ence of parents. The first is a questionnaire, similar to that employed by
other investigators, (Benfield et al., 1976; Benfield, Leib, & Vollman,
1978) containing 10 common symptoms (sadness; crying; difficulties
eating; sleep disturbance; feelings of weakness or exhaustion; irri-
tability; social withdrawal; feelings of guilt or responsibility; preoccupa-
tion thinking or dreaming about the baby; anger) which, taken together,
could be considered a measure of grief or mourning. The second, the
Tennessee Self-Concept Scale, is a multidimensional instrument that has
allowed some understanding of the effects of perinatal death on self-
esteem.

Mothers
Simply put, mothers mourn more than do fathers in reaction to a
perinatal death; they report more sadness, more crying, more sleep
difficulties, more preoccupation, more anger, more guilt. Such findings
seem unsurprising in light of the truly intimate (literally symbiotic)
Perinatal Death 265

relationship a mother has with her unborn child, an experience the

father cannot share. While the fetus "becomes real" for the mother with
its movement during the course of the pregnancy, until birth it is not in
reality a separate person-it is a part of the mother, and utterly depen-
dent upon her. This factor of complete responsibility for the develop-
ment and nurturing of a potential person appears to offer the most
straightforward explanation for the greater grieving of mothers. It is also
consistent with the suggestion of Parkes (1965) that the intensity of
mourning after a loss is proportionate to the closeness of the relation-
ship prior to death.
Unlike fathers, almost all mothers manifest moderate to severe guilt
in reaction to a perinatal death. These mothers have "failed" in the tasks
of developing and nurturing, and their statements (which contain indi-
cations of magical thinking, such as fantasies of being punished by God
or beliefs of having directly harmed the fetus with thoughts or feelings)
indicate that it is this failure-to themselves, to their husbands, and
(fatally) to their infants-that evokes the characteristic response of guilt.
Although in the tenets of psychoanalytic theory it is the hostile
components of ambivalence, including death wishes, that produce guilt
at the death of a significant person, I would suggest that guilt is in fact a
"realistic" response to the uniquely responsible position of mothers;
how could one not feel guilty, for example, for failing to save from death
even an unknown person one "could" or "should" have saved? In this
situation, as Gardner (1969) points out, guilt may be essentially a de-
fense against a truly existential anxiety-the magical thinking stem-
ming from a wish to somehow control the uncontrollable, even at the
expense of taking the blame for it. But this defensive guilt can create a
profound isolation: The mother is afraid to disclose the "secret" (of her
culpability) to others; and, if she does, others (including-often espe-
cially-her husband) cannot tolerate the pain of her guilt, deny her the
primal responsibility she feels, and thus resist sharing her experience
and foreclose the potential for genuine intimacy.
Mothers incur not only guilt in relation to their "incompetence," but
also a loss of self-esteem; again by comparison to the statements of
fathers, they are more self-derogatory, feel more diminished, and experi-
ence themselves as more fragmented, less integrated. Freud (1917) states
that when the object-choice has been effected on a narcissistic basis
with death "the shadow of the object (falls) upon the ego" (p. 249). The
mother, a piece of herself gone, often feels that her purpose, her func-
tion, has been lost; "I feel empty ... I should be taking care of a new-
born-I don't feel like a woman who just had a baby." She may speak of
losing in an implicit competition with other women her age to have
children, and of failing to produce a gift, a grandchild, for her own
mother. Her experience is shameful, and frightening:
266 Douglas J. Peddicord

The newly bereaved mother may be reluctant to reveal typical reactions such
as transient hallucinatory experiences of a baby crying or the powerful urge
to steal another mother's infant for fear that she would be considered insane.
She may consciously suppress her tendency to cry in response to any re-
minders of babies fearing that if she is not able to control her grief, it will
overwhelm her and never end. (Leon, 1987, p. 187)

It can feel that there is no longer an acceptable, an adequate self to

disclose, to share, and she is further demeaned by comments such as lilt
was God's will" or "It's for the best" or "You're young, you'll have
another."

Fathers

To say that fathers display less mourning than do mothers is not to

say that they do not grieve. However, their relationship to the infant is
less intimate, and they mourn both less intensely and more quickly. By
comparison to mothers, fathers seem almost one step removed from
things and the focus of their attention is more diffuse. The most com-
monly felt concern is of the need to be in control-"I was blocking out my
feelings because I wanted to have my head clear to make decisions"; "I
couldn't really show much feeling, I needed to support my father and
her father, I was paying attention to everyone-only when I was alone
did I break down" (Peddicord, 1982, p. 93). Fathers talk of practical
issues, such as the need to make decisions regarding burial or the diffi-
culties of being the one who had the task of informing family and
friends of the infant's death or the conflicts felt in regard to competing
responsibilities, i.e., to wife, work, surviving children, etc. Some do feel
shortchanged by their role-"Everyone was telling me to be strong for
her and was asking about how she was doing, but I was hurting too!" -
but, on the whole, fathers seal over the experience as quickly as possible:
"I think I did all my crying at one time"; "I fight very hard for what I can
have, when I can't have it I drop it like a hot potato ... when the (twins)
were dead they were gone and I put it back behind me very fast" (Ped-
dicord, 1982, p. 93).
While mothers are internally focused in the aftermath of a perinatal
death, wondering "Why me?" or "What did I do?," fathers, when not
attending to the myriad tasks others seem to leave to them, tend to be
intellectualized, focused on abstract questions such as "What does it
mean?" Though they are unlikely to identify a diminishment of personal
identity, some do report feeling fundamentally changed by their loss.
They talk of feeling less in control of life, more at the mercy of "fate."
Some become more religious or more concerned with the ultimate mean-
ing of life. New perspectives are realized; for example, that having dealt
Perinatal Death 267

with genuine life and death, it can be hard to continue treating work or
career as the most important thing in one's life or, simply, that "half of
the details that keep you so busy are really incidental" (Peddicord, 1982,
p. 90). They question their values, their purpose. And some fathers
(especially those without other surviving children) feel disoriented-
having rearranged their lives, even changed jobs, in preparation for
parenthood, only to be faced with needing to reorder priorities, goals,
etc., yet again.
Their behavior limited by a cultural role that discourages expression
of feelings, and reluctant to confront (as mothers do) the vulnerability
and powerlessness inherent to their experience, fathers not infrequently
couple avoidance with acting-out. The diversion offered by working too
much or drinking too much or having an affair takes away the sting of a
shameful knowledge-that he too has "failed" in the attempt to create a
new life, has failed at the primary paternal function of protecting his
child.

Barriers to Disclosure
Parents confronted with a perinatal death live out a dreaded fear
come true, are denied a happy expectation the rest of the world takes for
granted. Yet at a time when they most need support, most need "narcis-
sistic supplies," mothers and fathers find their grief discounted, their
pain minimized.
In the death of an infant a primal separation anxiety is enacted-
fear of loss/abandonment becomes loss/abandonment. Fisher (1982)
points out that resistance (whether to therapy per se or to the sharing of
experience or to intimacy) can be understood as "humanity's constant
effort to avoid the pain of feeling, thinking, or reexperiencing nonbeing"
(p. 117). The literal nonbeing of the infant is nightmarish, and the resis-
tance-of parents to the acceptance of the event forced by the reality
principle, and of others to the possibility of establishing an identifica-
tion, of genuinely sharing the parents' experience-is the central barrier
to self-disclosure and authentic relatedness.

In the Couple

Schiff (1977) makes the point that, despite common assumptions

that at least this tragedy can be faced by the couple together, grief is in
fact a highly individual experience and often places enormous stresses
on the marital relationship. Fish (1986) puts it straightforwardly:
268 Douglas J. Peddicord

For parents who have lost infants, expect high levels of disagreement and
misunderstanding ... much higher levels of grief in mothers than in fathers,
greater eagerness in the father to return to normal (especially in sexual
relations), and consequent high stress on the marriage and consideration of
divorce, especially by mothers. (p. 426)

What factors could account for such significant communication dif-

ficulties within the couple, the one relationship in which empathy and
acceptance might be presumed? First is that husbands and wives go
through the experience of an infant's death separately and differently.
Symbiotically connected to the fetus/child, mothers frequently feel de-
pendent upon and at the mercy of the medical professionals treating
them; fathers, meanwhile, may become agents of those same profession-
als, e.g., sometimes the father is informed of the baby's death first and
the task of telling the mother then falls to him. And, as previously
mentioned, fathers are usually the ones who make the practical deci-
sions on issues ranging from medical treatment of the infant to burial
arrangements. In ways, then, husbands and wives are not equal partici-
pants in the event-in general, they are treated and they behave inde-
pendently. An equally important factor is that mothers and fathers
mourn incongruently; simply, fathers get through the process more
quickly and want to talk about their feelings, their "failings," much less.
In the author's research (Peddicord, 1982) support for the notion
that the quality of a couple's relatedness has a significant impact on their
experience of a perinatal death was found. For instance, those rated
positively on ability to talk to spouse reported more crying, but showed
higher self-esteem, more satisfaction with his/her body (body image),
and a better sense of personal worth; while those rated negatively evi-
denced more guilt and greater inadequacy, and were less likely to ex-
press a desire for further pregnancies. In brief, those who could disclose
themselves within their relationship were less diminished by their loss
and more confident about facing the future than those who could not.

Family and Friends

While parents themselves often feel confused about their reactions

to the death of an infant, other people seem to be even more disoriented
by confrontation with an event that is somehow taboo, (in part because
"in 20th century America people simply don't lose babies"). Although
many parents speak of feeling supported by family and/or friends, al-
most all recognize as well a profound discomfort on the part of others
and frequently the mother or father feels responsible for this, and then
endures "failing" an attempt to "make things better" (the way they
should be) yet again.
Perinatal Death 269

It is not uncommon for the birth of a child to promise a great deal-

perhaps a potential for a change in the relationships of the parents to
their own parents is involved or perhaps a maintaining of the family
line, the very survival of a given family. The disappointment of expecta-
tions across generations is felt keenly by mothers. At times they feel
called upon to console their own mother on the loss of "her" child
(grandchild), and experience their own pain as seemingly secondary.
Several mothers interviewed by the author felt demeaned by their
mothers or mothers-in-law who, after the infant died, recommended
against further pregnancies. This "protection" was perceived as a lack of
confidence, an indicator of the mother's inadequacy; e.g., "My hus-
band's mother had a lot of kids and can't really understand why some-
one could have trouble being pregnant" (Peddicord, 1982, p. 97).
If they have "disappointed" family, parents-especially mothers-
often feel that they have "lost" in relation to friends. Commonly, be-
reaved mothers feel painfully envious of pregnant friends, are unable to
accept the sympathy of female friends who have children, feel incredi-
bly angry at women who smoke or drink or otherwise do not "do it
right" (as they did) only to deliver healthy babies. Sad, angry, and
tainted by failure, mothers (and, in tandem, fathers) often find them-
selves shunned by friends if premorbid levels of activity and mood are
not returned to quickly. In our society the young cherish a belief in the
ability to control life, to plan it, to make it perfect-and parents who
have lost an infant are viewed, consciously or unconsciously, not as
victims of a random or fateful or uncontrollable tragedy, but as the
architects of their own failure and, as such, unacceptable.
Given the preceding commentary, it is not surprising that mothers
and fathers most often feel that genuine disclosure of their experience is
precluded. As one father, seen on follow-up some months later, com-
mented, "I've never known such aloneness as that funeral only my wife
and I went to ... that tiny white casket sitting on the ground ... the feel-
ing of that I don't think anyone could really understand."

Caregivers

Although the explosion of malpractice insurance rates has made the

specialty more difficult to pursue, obstetrics is still a generally happy
field of medicine and the tenor of the times is that there is nothing more
natural, nothing more free of risk, nothing less in need of interference
by the medical establishment than the birth of a child. While that may be
true 92%-96% of the time, for pregnancies that progress past the first
trimester, it appears that physicians, as well as parents, feel distressed
270 Douglas J. Peddicord

by the 4%-8% of cases that do not end happily, the cases that constitute
their "failures." Most often men, and trained to be in control always, like
fathers they have difficulty tolerating, let alone expressing, feelings of
vulnerability and powerlessness in the face of tragedy, and like fathers
they tend to use avoidance and rationalization. Nearly half the mothers
interviewed by the author said that their doctors responded inade-
quately at the point in time when the pregnancy went from normal and
uneventful to potentially catastrophic, for example, with premature la-
bor-they felt placated, not taken seriously, treated as hysterical.
Mothers often felt "dumped" or "abandoned" then when transfer to the
care of attending physicians at a high-risk, regional neonatal center was
initiated-and frequently the doctor who had been following the preg-
nancy did not make further contact with his patient.
In trying to "protect" parents from the reality of their experience,
caregivers at times make stunningly incorrect assumptions. For in-
stance, a nurse commented to an unmarried, teenage mother that her
loss, a stillbirth, must have been in some way a relief (presumably be-
cause her circumstances for raising a child would have been so difficult);
the young woman experienced the interaction as denigrating and cruel,
because she was counting on the child to give her "purpose ... I was
finally going to do something ... 1 had something to put my life into"
(Peddicord, 1982, p. 107). Another assumption is that a stillbirth is some-
how less real, less painful, than the loss of a live-born infant, but the
mother (and, to a lesser extent, father) has in fact lived with the fetus for
a number of months and what she (he) deals with is not simple removal
of a "benign tumor." One mother said, "After so much attention in the
delivery room the night before, no one came in to talk or help me clean
up or anything ... but I had had a baby!" (Peddicord, 1982, p. 100).
Sometimes caregivers assume a model of grieving that proceeds by
neat "stages." Not uncommonly parents are characterized then as
mourning incorrectly; not talking, not sharing their feelings enough, for
example, or remaining "stuck" in anger and guilt (emotions that care-
givers find especially uncomfortable, unreasonable). But the experience
of parents cannot be grasped so easily; a willingness to understand the
meaning of this death/loss to this particular person, to appreciate this
individual's character structure and defenses, to allow and feel a pain
that threatens to annihilate the self, is required. Grief is not so much a
problem to be solved as a process in which caregivers can be genuine
participants. Self-disclosure and intimacy are two-way streets and for
most caregivers the resistance is too great-they neither disclose (to the
other or to themselves) their own internal contents nor do they truly
apprehend the experience of the mothers and fathers with whom they
come in contact.
Perinatal Death 271

Self-Disclosure and Its Effects

Although researchers have expressed concern about intruding
upon parental grief, participation rates reported in studies of perinatal
death have been unusually high. Mothers and fathers feel deep needs to
understand and to be understood, and consistently are grateful for
opportunities to tell their stories. Many intuitively believe that only
another bereaved parent can fully appreciate (and tolerate) the tragedy
and in self-help groups such as The Compassionate Friends and
AMEND the act of sharing one's experience, of self-disclosure, becomes
a part of the parent's search for meaning, imparts some purpose to the
child's life and the parent's loss. Hopeful of helping others, parents
recognize that revelation by one who has also lost a part of himself!
herself not only validates the grief but suggests that it can be survived.
In my research, and in several psychotherapy treatment situations
since, I have made parents aware that I suffered the loss of a newborn
son in the past. With many parents I have found that some degree of
sharing and/or straightforward education - offering information gath-
ered from the literature or supportive comments regarding the normalcy
of a parent's reactions or some personal experience - has served to re-
duce the individual's anxiety to a manageable level and elicited a freer
responsiveness. Disclosure and openness offer the parent permission to
see, to feel, to touch his/her wounds and thus to mourn. This stance
suggests that the author, having lived it, will not be overwhelmed by the
anxiety provoked by a perinatal death, so even "crazy" thoughts, feel-
ings, wishes, impulses, etc., can be expressed.
Though analytically oriented and most comfortable with being a
reasonably neutral object onto which patients project, in the situation of
my research and several therapies since, for me it would have felt inau-
thentic not to disclose. Acknowledgment of personal experience seemed
not an intrusion or countertransference manifestation, but a bridge to
genuine relatedness. From the point of view of the patient, who is al-
ready intensely preoccupied with a sense of narcissistic inadequacy, the
intact, undamaged (idealized) therapist may evoke rage and the belief
that he/she can never empathize with the patient, can never know what
it is to have failed so horrendously. Leon (1987) comments about one
case, the mother's "transference was marked by both admiration and
envy of her female therapist. She has the powerful conviction that every-
thing desirable and valuable was in her therapist's domain" (p. 188).
While transference distortions can be analyzed and worked through if
the patient remains in treatment, an intense initial negative transference
can be overcome (and the opportunity for treatment preserved) by the
therapist's disclosure of shared experience, which establishes both a
272 Douglas J. Peddicord

present identification and a hope for the future, i.e., "if the therapist
could be repaired perhaps I can be also." A genuine person, the self-
disclosing therapist can (as in all therapies) be hated too, but the
patient is less likely to worry that herlhis own disclosures will induce
abandonment.
With the common unwillingness of friends, family, and even care-
givers to tolerate the primitive anxiety engendered by the death of an
infant, to acknowledge the parents' loss in a genuine way, or even to
allow mourning to occur, often the greatest pain of a perinatal death is in
the aloneness it creates; internal devastation and emptiness are matched
by external isolation. It is that barrier to intimacy which self-disclosure
by a caregiver or therapist can breech, which self-disclosure by a parent
can overcome.

References
Benfield, D. G., Leib, S.A., & Reuter, J. (1976). Grief response of parents after referral of the
critically ill newborn to a regional center. New England Journal of Medicine, 294,
975-978.
Benfield, D.G., Leib, S.A., & Vollman, J.H. (1978). Grief response of parents to neonatal
death and parent participation in deciding care. Pediatrics, 62, 171-177.
Cullberg, J. (1971). Mental reactions of women to perinatal death. In N. Moriss (Ed.),
Psychosomatic Medicine in Obstetrics and Gynecology, Third International Congress. Lon-
don: Karger-Basel.
Fish, W.C (1986). Differences of grief intensity in bereaved parents. In T.A. Rando (Ed.),
Parental loss of a child. Champaign: Research Press.
Fisher, M.N. (1982). The shared experience: A theory of psychoanalytic psychotherapy. In
M.N. Fisher & G. Stricker (Eds.), Intimacy. New York: Plenum.
Freud, S. (1917/1958). Mourning and melancholia. Standard Edition of the Complete Psycho-
logical Works of Sigmund Freud (Vol. 14). London: Hogarth Press.
Furman, E. (1976). Caring for the parents of an infant who dies: Comment. In M.H. Klaus
& J.H. Kennell (Eds.), Maternal-infant bonding. St. Louis: Cv. Mosby.
Gardner, R.A. (1969). The guilt reaction of parents of children with severe physical dis-
ease. American Journal of Psychiatry, 26, 636-644.
Kennell, J.H. Slyter, H., & Klaus, M.H. (1970). The mourning response of parents to the
death of a newborn infant. New England Journal of Medicine, 283, 344-349.
Leon, I.G. (1987). Short-term psychotherapy for perinatal loss. Psychotherapy, 24, 186-195.
Lindemann, E. (1944). Symptomatology and management of acute grief. American Journal
of Psychiatry, 101, 141-148.
Lippman, CA., & Carlson, K. (1977). A model liaison program for the obstetrics staff. In
CE. Hollingsworth & R.o. Pasnau (Eds.), The family in mourning: A guide for health
professionals. New York: Grune & Stratton.
Mazor, M.D. (1979). Barren couples. Psychology Today, May; 101-112.
Miles, M.S., & Demi, A.S. (1986). Guilt in bereaved parents. In T.A. Rando (Ed.), Parental
loss of a child. Champaign: Research Press.
Parkes, CM. (1965). Bereavement and mental illness. British Journal of Medicine and Psychol-
ogy, 38, 13-26.
Peddicord, D.J. (1982). Perinatal death: some aspects of parental reactions (Doctoral disser-
tation, Adelphi University, 1982). Dissertation Abstracts International, 43, 1263B.
Perinatal Death 273

Peppers, L.G., & Knapp, R.J. (1980). Motherhood and mourning: Perinatal death. New York:
Praeger.
Rando, T.A. (1986). The unique issues and impact of the death of the child. In T.A. Rando
(Ed.), Parental loss of a child. Champaign: Research Press.
Schiff, H.S. (1977). The bereaved parent. New York: Crown.
 VI
Conclusion
 18
Self-Disclosure and Psychotherapy
George Stricker

Self-disclosure lies at the heart of psychotherapy, the talking cure. It can

be defined, somewhat tautologically, as a process by which the self is
revealed. That ambiguous definition does not state who is doing the
revealing, to whom, or by what means. Each of these ambiguities is
critical within the therapeutic relationship. Either the therapist or the
patient may be self-revealing, the revelation may be to the other person
or to the self, and the means may be verbal or nonverbal, conscious or
unconscious.
Fisher, adopting an existential position, describes very clearly that
the resistances and transferences that we address in the therapeutic
situation are not confined to the therapy. Rather, they are characteristic
of the patient's general mode of functioning, and their resolution in
treatment is valuable insofar as it can be generalized to the world out-
side the treatment room. The key resistance is not to the therapist's
knowing, but to the patient rediscovering a disavowed portion of him-
self. The essential secrets are not being kept from the therapist, primar-
ily, but from the self. The therapist is merely a conduit, a way station
who encourages and allows the patient to explore ideas, risk disclosures,
and come to understand that these secrets are not destructive, can be
tolerated by others, and perhaps even can be tolerated by the self. There-
fore, the central self-disclosure to be sought is not to the therapist but to
the self.
The role of the patient, for Fisher, is simple. He reveals himself to the
therapist for the purpose of discovering himself, and by doing so is

George Stricker. Institute of Advanced Psychological Studies, Adelphi University,

Garden City, New York 11530.

277
278 George Stricker

freed to live a more authentic and fulfilled life. The role of the therapist is
less simple. Disclosure is part of a relationship between equals, it can
serve to model the comfortable expression of uncomfortable experi-
ences, and it also creates a climate in which self-revelation is acceptable
and valued. The therapist must recognize, however, that it is the growth
of the patient that is paramount, so that the disclosure is confined to
experiences occurring in, or relevant to, the treatment.
As long as the growth of the patient is paramount, there is some
question whether a relationship that is inherently asymmetric really is
between equals. More likely, two individuals meet who are equal in
their humanity and in their adult status, unequal in the particular rela-
tionship in which they find themselves, and, by disclosing themselves
to each other, they close the gap between themselves in the treatment.
Perhaps it might even be said that as equality increases, the need for
treatment decreases, and treatment ends well when the two participants
are equal in the room, as they are outside it. This statement also sug-
gests that the limits of treatment may be set by the limitations of the
therapist, for the patient cannot be taken any further than the therapist
has traveled.
Healey takes a historical perspective and views self-disclosure as a
part of the Judeo-Christian religious experience. Indeed, as this experi-
ence was, and for many people still is, an essential healing experience,
the parallel to psychotherapy is compelling. The key to the religious
experience lies in the disclosure of the individual to God and of God to
the individual. The priest/rabbi serves as the mediator between God and
the individual, much as a therapist plays an essential role in the dis-
closure of the individual to the self. The role of relationship and trust is
central to self-disclosure in the religious experience, as it is in the thera-
peutic experience, and the role of ritual in both experiences cannot be
overlooked. The intent of the two experiences may be different, but the
process bears striking similarity, as does the central role of the self.
Healey does suggest that one essential difference is that psycho-
therapy is dyadic (patient and therapist) but religious experience is tri-
adic (individual, spiritual director, God). One may take a sacrilegious
view and suggest that psychotherapy is also triadic, and that our princi-
ple goal is to bring the patient in closer touch with the God within. This
internal God may be variously conceptualized as the superego, the par-
ental introjects, or the authentic self. In any case, the disclosure of the
individual to this forbidden internal component, and the acceptance of
the dread secrets by that component, carry the seeds of forgiveness,
acceptance, and growth. The religious person, through disclosure of
sinful or heretical thoughts and feelings, and the acceptance of these,
will experience himself as achieving greater communion with his God.
Self-Disclosure and Psychotherapy 279

The therapy patient, through disclosure of unacceptable thoughts and

feelings, and the acceptance of these, will experience himself as reach-
ing greater internal unity.
Lane and Hull, writing from a psychoanalytic point of view, focus
on the issue of therapist self-disclosure in individual therapy. The foun-
dation of psychoanalytic technique was laid by Freud, who espoused,
in writing, the total absence of any disclosure, but, in practice, was
remarkably active and disclosing. Freud did not consider the possibility
that nondisclosure is impossible, in that the absence of a statement
constitutes a statement in its own right, so that the silent analyst is
presenting a very powerful stimulus to the patient. The counterpoint to
Freud was established by Ferenczi, who experimented with a variety of
disclosing technical innovations, reaching an extreme with mutual anal-
ysis. This approach may be the logical extension of Fisher's concept of a
therapeutic relationship between equals, and needs to be moderated by
a recognition of the primacy of the patient's needs. Ferenczi also discov-
ered, in his experiments, and as has been noted previously, that the
personal limitations of the therapist place a boundary on the growth of
the patient. However, the resolution to those limits is not the respon-
sibility of the patient in the therapy (mutual analysis), but of the thera-
pist in his own treatment.
Contemporary developments in psychoanalytic theory allow for the
possibility of therapist self-disclosure, leaving unanswered questions
concerning the choice, timing, and amount of material to disclose.
Nonetheless, there is still the thought that self-disclosure is a dangerous
parameter to be employed carefully and judiciously, and that self-dis-
closure certainly should be limited to those revelations that may demon-
strate empathy and acceptance. The range seems to run from Langs,
who is a strict adherent to a basic frame, not allowing for any deviation
without risk of misalliance, to Khan, whose free use of himself, in the
mind of many, carries him beyond the pale of psychoanalysis.
Basescu also focuses on the self-disclosure of the therapist, al-
though he does so from an existential orientation that more closely re-
sembles the approach of Fisher. Basescu cogently argues that the key to
the acceptability of the classical psychoanalytic position concerning an-
onymity/neutrality rests with the relative weight given to the role of
fantasy and reality. If the meat of psychoanalysis is the fantasy of the
patient, the analyst is best advised to remain neutral and not intrude on
that fantasy. However, if reality is given considerable weight, the real
relationship becomes more important and the therapist must recognize
that any behavior, including anonymity, will have stimulus value and
must be taken into account. Neutrality, then, is not identified with ano-
nymity, but with the therapist's attempts to help the patient to under-
280 George Stricker

stand all aspects of the relationship and to leave all decisions about the
patient's life in the hands of the patient. With this conception of neu-
trality, it is possible to self-disclose and to remain neutral.
Basescu uses the interesting phrase "show and tell" in his title. It
points out that some of the self-disclosure is unavoidably shown, such
as the therapist's clothing, voice quality, office appointments, etc.; but
other aspects of self-disclosure are consciously told. The therapist must
be aware of both, and strive for understanding of the motivation behind
and impact of both. Just as we ask the patient to strive to understand, it
is critical for the therapist to understand the motivation behind self-
disclosure. Self-disclosure is not inherently good or bad; it can be well-
timed, well understood, geared to the needs of the patient, and highly
constructive; it also can be random, defensive, countertransferential,
geared to the needs of the therapist, and deleterious to the course of the
treatment.
Josephs approaches self-disclosure from the standpoint of self psy-
chology, a particularly relevant theoretical position given the emphasis
that has been placed on disclosing to the self. The distinction that is
drawn between the verbal self and the experiential self is a crucial one,
and one of the primary functions of self-disclosure is to narrow the gap
between these two selves, so that the sometimes false, presented self
becomes consistent with the authentic, experienced self.
Josephs also emphasizes the essential intersubjectivity of any self-
disclosure. In order for self-disclosure to occur, there must be a person
who self-discloses and a person who receives the self-disclosure. When
the discloser is the patient and the receiver is the therapist, the therapist
serves a self-regulatory function, aiding the patient in developing a
clearer sense of the meaning and import of the self-disclosure. When the
discloser is the therapist and the receiver is the patient, the patient may
also serve a self-regulatory function for the therapist but, more impor-
tantly, that same information is used to further develop a sense of the
experiential self. Two important conclusions follow from this formula-
tion. First, a recognition of intersubjectivity also involves a necessary
opting for reality over fantasy, as more value is placed on the quality of
the real relationship than on an illumination of the construction of a
fantasied relationship. Secondly, the intersubjectivity can be triadic,
with the patient, the therapist, and the patient's experienced but not
verbalized self all participating. Of course, the therapist'S experienced
self is also a participant; but that is not the focus of the therapeutic
encounter. In this model, the patient will verbalize a self-disclosure,
receive information from the response of the therapist, and modify the
conception of the experienced self as a result. Similarly, the patient may
receive a self-disclosure from the therapist, attempt to integrate it, and,
Self-Disclosure and Psychotherapy 281

by doing so, reach a modification of the experienced self. If an increase

in the patient's self-awareness is a goal of treatment, it can readily be
seen that there is a need for an increased disclosure to oneself.
Dryden approaches the topic of self-disclosure through the eyes of a
rational-emotive therapist, a departure from the predominant psycho-
analytic preference of the majority of the authors of this book. Although
the meta psychological premises of the two orientations are vastly differ-
ent, they do share a high regard for rationality and self-understanding.
Thus, self-disclosure is also valued within a rational-emotive and, more
generally, a cognitive-behavioral framework, although a primary differ-
ence about the role of the unconscious remains.
Perhaps even more than with regard to the role of the unconscious,
the two theories differ in their conception of the technique by which the
therapist is able to promote change. The rational-emotive therapist is far
more active and directive than even the most self-disclosing psycho-
analytic therapist would be, but does work toward a more passive posi-
tion in which the burden of the treatment can be assumed by the patient.
In contrast, the psychoanalytic therapist is more likely to begin with
maximum passivity and gradually introduce activity and self-dis-
closures as the judgment is made that the patient would benefit from
them. In both approaches, the therapist is an enabler, and the patient's
key self-disclosure is to the self, conceived variously by the two
orientations.
The approaches agree as to the human equality of the two partici-
pants in a therapeutic encounter, but the rational-emotive therapist is far
more likely to use that equali~ and his own human foibles, as a medium
to promote therapeutic growth. The self-disclosure that is a parameter
within psychoanalysis is a treatment technique for rational-emotive
therapy. Rational-emotive therapists are more likely than psycho-
analysts to disclose personal events and their solutions, whereas both
are inclined to disclose personal reactions to the patient, and to do so in
order to provide information about the impact of the patient. Self-dis-
closure is used for modeling purposes in both, but in psychoanalysis it
is modeled as a process, with the hope that the patient will also begin to
explore and feel safe with threatening and unwelcome thoughts and
feelings. In rational-emotive therapy, self-disclosure is used to model a
successful coping style, to show how the rational-emotive approach can
be used effectively to solve personal problems, and to teach the philoso-
phy and technique more directly.
Jackson focuses on unintentional disclosures by the therapist, and
does so from a psychoanalytic vantage point. He contrasts those in-
stances of intentional self-disclosure that are planned and generally
outside the limits of traditional psychoanalytic practice with examples
282 George Stricker

of unintentional self-disclosure that are unavoidable and present in all

therapies, regardless of the orientation of the practitioner. Special
events, such as the pregnancy of the therapist, as well as implicit com-
munications, such as are inherent in any personal exchange, fall into the
class of unavoidable self-disclosures. The point is made that inten-
tionally providing the patient with information inhibits the ability of the
patient to discern for himself, as self-disclosure will occur in any event.
The notion of the active patient,'rather than a passive and naive patient,
suggests that both participants in the treatment are actively and simul-
taneously construing the other.
If this be the case, self-disclosure is unavoidable, and the only ques-
tion becomes the mix between reality and fantasy that will contribute to
the construal. The more the therapist reveals, the more the patient will
have a realistic picture, nonetheless tempered by past experiences and
characterological distortions, The less the therapist reveals, the more the
patient will construct a picture from these past experiences and charac-
terological distortions, but there will still be input from the unintended
disclosures that occur in the therapeutic transactions. The choice be-
tween these will be a function of the therapist's theoretical position,
personal style, and comfort zone, and it is difficult to suggest that one
stance is better than the other. What does seem clear is that the therapist
who believes that the patient's productions are entirely transferential is
missing the impact of unintentional self-disclosures that occur natu-
rally. At the same time, the therapist who believes that the patient's
productions are a veridical reflection of the therapist's stimulus value is
ignoring the vast history that leads the individual to cast particular
behaviors in uniquely interpreted ways.
Menaker also is concerned with the self-disclosure of the therapist,
discusses its implications for transference and countertransference, but
does so with an atypical and highly personal style. She expresses more
willingness than most of the authors to reveal the details of her life; but
the rationale is the very familiar position that it does not do justice to an
understanding of the transference to view the necessity of cultivating it,
for it will arise in all human relationships. She recognizes the implicit
revelations that are part and parcel of all human communication. How-
ever, she goes beyond that, revealing herself not only in unavoidable
implicit ways, not only by reflecting personal feelings about the patient,
but by providing personal information about herself. This is done in the
service of creating a relationship in which attunement is present and
communicated, and the intersubjectivity of the participants is stressed.
As a real human relationship is created, and is enhanced by the self-
disclosures that flow in the reciprocal relationship between therapist
and patient, a matrix is also created within which previous developmen-
Self-Disclosure and Psychotherapy 283

tal deficits can be repaired. It is crucial to recognize that the self-

disclosures of the therapist are not random, conversational, or self-serv-
ing, but are chosen, both carefully and spontaneously, to communicate
an empathic understanding of, and bond with, the patient.
There are some issues that cut across therapeutic orientations, and
are present whether we view the therapeutic phenomena from a dy-
namic, behavioral, or existentialist perspective. One of these issues con-
cerns work with nonwhite ethnic minority patients, and this is the topic
of concern to Jenkins. The first issue of concern in the treatment of
nonwhite ethnic minority patients is the reduction of the dispropor-
tionately high attrition rate that is so characteristic in work with these
patients. Jenkins asserts that nonwhite ethnic minority patients are
highly active in testing the therapist in early sessions, and will not
proceed until they are satisfied that they will be treated with under-
standing, respect, and dignity. Before self-disclosure will be risked, the
nonwhite ethnic minority patient must be assured that the climate in the
treatment room is more receptive than it is in the dominant society. This,
of course, must truly be the case. If so, as we have seen, one approach to
providing this assurance, particularly with a patient who is sensitized
towards indications of inequality in the relationship, is the use of appro-
priate self-disclosure by the therapist. The sequence that may ensue
consists of self-disclosure by the therapist, which encourages self-dis-
closure by the patient, which leads to breadth and growth in the authen-
tic, experiential self of the patient.
The principle medium for self-disclosure is language, and this can
introduce complications when working with nonwhite ethnic minority
patients who, for sociocultural reasons, may have been brought up with,
or communicate in, a different language, verbal or nonverbal, than the
therapist. The bilingual person has a well-documented problem of gain-
ing access to early developmental issues in a language other than the
one in which those issues were experienced. It is also well-known that
there is a subtle prejudice towards those who cannot speak our lan-
guage, the assumption being that these differences are deficits, and are
indicative of either a lack of intelligence or the presence of psychopathol-
ogy. The existence of a parallel problem for bidialectic patients is not as
broadly appreciated. Jenkins also contributes the creative suggestion
that patients be encouraged to provide self-disclosures in their most
comfortable language, even if the therapist does not speak that lan-
guage, with the experience then being available for discussion between
them. This strategy has the dual appeal of facilitating a heightened
affective experience for the patient and communicating a respect for the
power of the patient's linguistic and sociocultural background.
A second issue that cuts across orientation concerns is the treatment
284 George Stricker

of women, as discussed from a feminist perspective by Brown and

Walker. Self-disclosure by the therapist has always been an integral part
of the feminist approach to treatment because, consistent with the posi-
tion of many contemporary psychoanalysts and humanistic therapists,
it is seen as empowering for the patient. This disclosure includes per-
sonal values and biases as well as life experiences, and is a step in the
direction of promoting an egalitarian psychotherapeutic relationship. In
order to make an appropriate choice of therapist, patients (always re-
ferred to as "clients" in feminist writings) are encouraged to solicit self-
disclosure on key value-laden issues.
Placing a premium on self-disclosure also requires careful attention
to the risks and ethical considerations raised by such activity, a topic
that Brown and Walker address explicitly and clearly. One such issue is
boundary management. All self-disclosure must be in the service of
the patient's needs, and the ability of the therapist to modulate self-
disclosure and seek other, more appropriate, sources of support pro-
vides the patient with a mature model of the respect for and value of
personal boundaries. A further problem can occur if the therapist over-
generalizes from her own experience and loses touch with the individ-
ual predicament of the patient. Not only will this lead to inappropriate
solutions, it also will reduce the patient's range of options and control
over her fate, thereby undermining two important goals of feminist
therapy. A good rule of thumb is the principle that has been enunciated
previously, that the self-disclosures of the therapist should not be ran-
dom, conversational, or self-serving, but should be chosen, both care-
fully and spontaneously, to communicate an empathic understanding
of, and bond with, the patient.
There are special considerations involved when the treatment is not
individual therapy with adult patients. One such consideration is in
working with children and adolescents, an issue discussed by Pa-
pouchis. As a point of departure, Papouchis identifies himself as believ-
ing that, with adults, disclosures about reactions to the patient should
be sparing and disclosures about personal events should be rare, even
though the self-disclosure of the patient is one criterion of successful
therapeutic outcome. Nonetheless, with children, the therapist must be
mindful of the developmental stage and task, and moderate the use of
self-disclosure accordingly. For example, in contrast with the prescrip-
tion for working with adults, verbal exploration of psychodynamic issues
with the latency-age child may be overwhelming and counterproduc-
tive, but self-disclosure by the therapist is an empathic response to the
child's growing wish to learn about the surrounding world. Similarly,
with adolescents, excessive self-examination may not be tolerable for a
growing ego, and therapist self-disclosure helps to provide an alterna-
Self-Disclosure and Psychotherapy 285

tive role model in a more egalitarian setting. With both children and
adolescents, the limitations of a developing ego are respected and, while
respecting the presence and importance of the parents, the need for an
empathic, reality-bound adult is understood.
There is a logical extension of this sensitive, developmentally based
approach to the use of self-disclosure. It is clear that children and ado-
lescents usually are caught up in developmental tasks that make the
additional burden of self-disclosure sometimes too overwhelming to be
therapeutically valuable. It is also clear that, either despite or because of
the presence of parents, they often require a clear, empathic adult to be
available as a role model and an object of attachment. It is not as clear
why the chronological passage of time automatically erases these con-
siderations. For many adults, self-disclosure may also represent a bur-
den that must be tempered by the careful therapist, and the need for an
empathic role model or attachment figure has not disappeared with the
passing years. It seems likely that the titration of self-disclosure should
be geared to developmental needs, regardless of the chronological age of
the patient.
At the other end of the developmental spectrum, special considera-
tions are also indicated in working with older adults, the topic of Green-
berg's chapter. This chapter is built on a strong research foundation,
with much evidence cited that indicates the value of a confidant in the
adjustment and happiness of an elderly person. Intimate relationships
seem to serve as a buffer against demoralization and depression, and
self-disclosure is an important contributor to intimacy. In psycho-
therapy, some writers view an empathic, supportive relationship, but-
tressed by the therapist'S use of self-disclosure, as an end in itself,
providing the elderly patient with gratification that is absent elsewhere
in his life. Although this may be of value to some, there are many elderly
patients who can benefit from standard psychotherapy, with self-
exploration and growth seen as realistic and legitimate goals. For these
patients, the considerations governing the use of self-disclosure are
much the same as they would be for other adult patients, with judg-
ments about the needs of the patient and the capacity of the therapist
determining the introduction, appropriateness, and timing of any self-
disclosure. As with any patient, revelations communicating affective
attunement are likely to be helpful, and those displaying unresponsive-
ness or misattunement are not. On the other hand, the patients may not
be as free to self-disclose as a younger person might, stemming in part
from the norms to which this age cohort was socialized, as well as from
more dynamic concerns that might be subject to the same interpreta-
tions and interventions as would occur with younger patients.
Consideration must also be given to modalities other than individ-
286 George Stricker

ual therapy. Vinogradov and Yalom present issues in self-disclosure in

group therapy. A distinction is made between horizontal self-disclosure,
in which the past or the outside is disclosed, and vertical self-disclosure,
dealing with intragroup, interpersonal issues. The group often focuses
on vertical self-disclosure, whereas individual therapy often is con-
cerned at least equally with horizontal self-disclosure. Among the func-
tions of self-disclosure in a group are to increase cohesiveness and to
develop interpersonal learning, effeds that they may also have in a
nontherapeutic situation. It is this potential to transfer interpersonal
learning from the group to real life that is such a critical factor in the
efficacy of group therapy. The important point is made that self-dis-
closure, in order to be constructive, must be tempered by empathy and
responsibility. The patient in group therapy must learn to guide self-
disclosures by the impact it will have on co-participants, whereas the
patient in individual therapy need not be overly concerned by the impact
on the therapist. Both the individual and the group therapist certainly
should have all self-disclosures (both about himself and about the pa-
tient) guided by empathy and responsibility. Although the group thera-
pist is likely to be more self-disclosing than the individual therapist, he,
too, must be guided by an understanding of the meaning and impact of
each disclosure and must always place the needs of the group above his
own needs in determining what and when to disclose.
Much of the material presented to this point was based on clinical
experience and theory. There also is a good deal of research evidence
relevant to self-disclosure, some of which is directly relevant to therapy
and some of which refers to self-disclosure in the world at large. Simon
developed a list of the functions of intentional therapist self-disclosure
that was based on interviews with eight experienced therapists. These
functions, then, are not the idiosyncratic experiences of a single thera-
pist, no matter how skilled, but a compilation of the beliefs and practices
of a small number of experienced therapists. However, it must be noted
that the high disclosers in this study were primarily identified with a
humanistic, nonpsychoanalytic viewpoint, whereas the low disclosers
were more likely to be psychoanalytic in orientation. Many of the au-
thors in this volume are perfectly comfortable with a psychoanalytic
orientation that incorporates humanistic features and also allows for
self-disclosure. Nonetheless, both groups in the study noted similar
functions of self-disclosure, differing only in their frequency, content,
and motivation for self-disclosure. It is likely that most of these func-
tions would be noted, as well, by the more traditional therapists repre-
sented in this volume.
The first function indicated by the therapists is that of modeling.
Self-disclosure by the therapist presents the patient with a model of an
Self-Disclosure and Psychotherapy 287

effective, assertive, high-functioning, and competent human being. It

was also noted, much as Papouchis stated, that this was particularly
important with adolescents. A second function was to foster the thera-
peutic alliance. This suggested very early disclosure of demographic
information for all therapists, and the use of self-disclosure to resolve
therapeutic impasses on the part of some. It also led some low self-
disclosers to note that withholding information was sometimes neces-
sary to protect the therapeutic alliance, and it provided a respect for
boundaries that sometimes seemed blurred in the high disclosers. The
third function was to validate reality. If a patient senses a feeling or event
and the therapist, in the service of anonymity, refuses to validate it,
the patient is left with an experience of his own lack of attunement to
the world, and this is therapeutically counterproductive. The en-
couragement of the patient's autonomy is a fourth function of therapist
self-disclosure. The respect for the equality of the patient that can be
conveyed by a self-disclosure provided a good reason for many thera-
pists, although they also noted that an intrusive self-disclosure could be
too much of a burden for some patients. This represents another exam-
ple of the need to be sensitive to boundary issues while engaging in self-
disclosure. Finally, the function of self-disclosure for some people was
therapist satisfaction, a by-product that must be acknowledged, but a
function that surely is not the primary goal of a patient's psychotherapy.
It is important to separate the gratification that one can derive from the
process and outcome of treatment from the narcissistic self-indulgence
that can occur if the focus of the treatment shifts from the patient to the
therapist.
Gordon's research did not concern psychotherapy per se, but the
role of self-disclosure in Holocaust survivors. Her results attest to the
power of self-disclosure in the world outside the treatment room and, by
doing so, suggest the value to the patient of a process that can facilitate
and encourage self-disclosure. The extent to which a survivor of the
Holocaust was able to disclose her terrible experiences was related to the
extent to which her daughter was found to be in touch with her own
experiences. This inter generational transmission of skill in self-
disclosure is a fascinating finding and points to the value of clear com-
munication to the receiver as well "as the sender.
Further, Gordon's use of a measure of referential activity highlights
another important aspect of self-disclosure. Referential activity refers to
a person's ability to translate experience into language, to be in touch
with one's own inner experiences. It suggests that there are two neces-
sary stages for self-disclosure to occur. First, the individual must have a
sufficient level of referential activity to be in touch with that experience,
thereby disclosing to the self. Having accomplished this, the ability to
288 George Stricker

disclose to others then becomes possible, although some people may

choose not to do so. Apparently, parents who choose not to do so risk
hampering the growth of their children, who may not develop the refer-
ential skills necessary to allow them to progress to the stage where they
may choose to disclose to others. This finding also suggests that the
therapist who encourages disclosure to the self is facilitating the ability
to disclose to others and, by doing so, enabling the patient to achieve
greater levels of intimacy in interpersonal relationships.
Frawley, too, describes a research project that shows the impor-
tance of self-disclosure in a nontherapeutic situation. Her subjects were
victims of childhood incest and thus were also survivors of an early
trauma. As with Gordon's Holocaust survivors, the horror of the early
trauma is surrounded by a veil of secrecy, one often encouraged, in the
case of incest, by the perpetrator. Further, disclosure of incest is often
met by disbelief, thus serving to reinforce the "necessity" of silence.
Most victims choose not to disclose their experience and, of those who
do, most are not believed. This stultification of any attempts at self-
disclosure is accompanied by gross failures at intimacy, most par-
ticularly in the sexual area, which already has been the scene of
overwhelming trauma. The shield that is constructed in order to keep
the knowledge of incest in also serves to keep others out.
Frawley provides both research and clinical support for the proposi-
tion that victims who engage in disclosure will be more likely to achieve
satisfaction in intimate relationships than those who preserve their aw-
ful secret. It appears as though self-disclosure has a critical role in
nurturing the capacity for intimacy in these victimized women, and the
task of the therapist must be to create a climate in which such disclosure
is safe and rewarding. Such a climate will be at marked variance with
the original parental environment, and will allow for the beginning of a
healing process that may compensate for the early developmental de-
fects. It should be noted, of course, that the effects of the self-disclosure
are neither painless nor magical. The revelation of a long-held secret is
often accompanied by much anguish, and the need for extensive work-
ing through is patently obvious. Nonetheless, the results are extremely
encouraging, and it does seem as though self-disclosure is a necessary
step in the treatment of incest survivors.
Finally, Peddicord describes a research project concerned with an-
other unthinkable area of trauma, grief, and guilt. The perinatal death of
a child is an experience of rare heartache. Even if the parents wish to
disclose, and the death is an open secret, they often find, even with each
other, that their pain is so intense and so individual that others prefer
not to hear about it. Much as with Frawley's incest survivors, it is not at
all helpful to try to sugarcoat the experience or to deny the individual's
Self-Disclosure and Psychotherapy 289

sense of guilt and responsibility. It is only by having the therapist (or

any concerned other) empathically validate the experience that the suf-
ferer can be free to work it through and move beyond it. It was also
demonstrated by Peddicord, as it was by Frawley, that self-disclosure
was accompanied by a better level of adjustment to the trauma.
We all want to believe in a just world, so that victims feel that they
must have done something to deserve the tragedy that befell them, and
others feel more protected from the tragedy if they can blame the victim
and, by doing so, insulate themselves from the threat of a similar trag-
edy. The therapist who enters into the conspiracy of silence will rein-
force silence and block the growth of the patient. The therapist who
allows the secret to be aired but denies the import, providing reas-
surance rather than empathy, disqualifies the experience of the victim
and adds to the victimization. The patient only learns that the self-
disclosure was meaningless and silence was, after all, the best available
strategy. It is only the therapist who can appreciate the honestly dis-
closed feelings of the patient, which are real even if they are also irra-
tional, who can provide the atmosphere that will allow the patient to
move beyond the irrational to a more self-accepting view. Thus, self-
disclosure is not an end in itself, but it is a necessary step on the path to
relatedness and intimacy.
Finally, let us return to some of the questions that were raised in the
initial definition of self-disclosure. That definition did not state who is
doing the revealing, to whom, or by what means. It should now be clear
that both the patient and the therapist engage in acts of self-disclosure,
they do so verbally and nonverbally, consciously and unconsciously, and
they reveal themselves to each other and to themselves. It is through the
self-disclosure of the patient to the therapist that he can begin to recog-
nize previously hidden and unacceptable aspects of himself, to recog-
nize the acceptability of what had been experienced as forbidden
secrets, and to grow in a healthier fashion. The self-disclosure of the
therapist serves as a model for the patient and also provides information
that encourages further disclosures and recognitions. Most importantly,
these disclosures and subsequent growth generalize beyond the therapy
session, leading to a pattern of relating that can be more spontaneous,
authentic, and revealing, and to a level of adjustment and relationships
that are more comfortable, fulfilling, and healthy.
Index

Abreaction, 98 Children and adolescents' therapy (Cant.)

Active technique, 35, 36 adolescent as special case, 165-169
Adolescents. See Children and adoles- adult therapy and, 159-162
cents' therapy developmental perspective, 162-167
African-Americans. See Ethnic minorities identification and, 170-172
Age differences. See Children and adoles- overview of, 157
cents' therapy self-disclosure concept in, 157-159
Agency. See Psychological agency therapeutic alliance and, 169-170
Alienation Classical psychoanalysis. See
factors contributing to, 3-4 Psychoanalysis
psychopathology and, 9, 10 Communication. See Language
Anonymity Confidentiality, 33
feminist therapy and, 139 Conflict, 108
projection and, 39-40 Consciousness, 77. See also Unconscious
psychoanalysis and, 51-52, 94 Consciousness-raising, 137, 151
self-disclosure and, 99 Consumer rights, 141-142, 148-149
Anxiety Countertransference
freedom and, 7 direct affective engagement and, 37
psychoanalysis and, 4, 35 neutrality and, 96
Archaeological analysis psychoanalysis and, 4, 36, 207
self psychology and, 85 self-disclosure and, 114-115
transference and, 107 self psychology and, 85
Attachment theory, 11 shared experience and, 13
Authenticity, 7 See also Transference
Authoritarian stance Culture
ethnic minorities and, 130 feminist therapy and, 146
feminist therapy and, 139 Holocaust survivors, 232
psychoanalysis and, 110 language and, 123-124
Autonomy, 219 paranoia and, 120
Avoidance,S, 9. See also Resistance race and, 118-119
self-disclosure and, 120-121
Basic trust. See Trust
Blank screen concept, 99. See also Ano-
nymity; Neutrality Death
anxiety and, 7
Children and adolescents' therapy, 157- avoidance and, 9
174 Deficit theory, 51

291
292 Index

Developmental factors Feminist therapy (Cont.)

children's therapy and, 162-167 overview of, 135-136
Holocaust survivors and, 232 problems in, 144-148
language and, 127 review of, 136-139
self psychology and, 108-109, 113-14 self-disclosure nature in, 141-144
Diagnosis, 222 Free association, 8
Direct affective engagement, 37 Freedom, 7
Domestic violence, 149, 150
Dream analysis Generalization, 277
inhibition and, 101 Group therapy, 191-204
psych~analysis and, 34, 48 overview of, 191-193
patient self-disclosure in, 193-198
Eclectic therapy, 209 therapist self-disclosure in, 198-203
Efficacy. See Outcomes
Ego, 107 Holocaust survivors, 227-245
Elderly. See Older adults developmental factors and, 232
Empathy implications of, 237-242
language and, 124 overviewof,227-228
neutrality and, 95 referential activity and, 233-234
psychoanalysis and, 33, 40, 160 study design, 234-237
self psychology and, 83-84, 85, 86 survival stages and, 228-232
shared experience and, 12 therapeutic implications, 242-243
transference and, 114 Humanistic psychology
Equality ethnic minorities and, 129-130
feminist therapy and, 139-141, 145 feminist therapy and, 143-144
psychotherapy and, 278 self-disclosure and, 32, 209
rational-emotive therapy and, 65-66
shared experience and, 11 Id,77
Ethnic minorities, 117-134 Implicit communication, 93-102
attrition problem and, 119 neutrality-seeking therapist profile,
contextual unit and, 130-131 100-101
cultural paranoia and, 120 self-disclosure (progressive views), 97-
early sessions with, 120-121 99
language and, 123-129 self-disclosure (traditional views), 93-
racial cultures and, 118-119 96
therapeutic relationship and, 129-130 special events, 96-97
Existential psychology Incest, 247-259
anxiety and, 7 incidence of, 247
authenticity and, 7 negative consequences of, 248-249
resistance and, 6-7 research in, 247
self-disclosure and, 158, 209, 277 secrecy and, 247-248
sexual dysfunction and, 250-251
Facilitator role, 144 study deSign, 250
Family therapy, 32 therapy with victims of, 251-257
Fantasy, 34, 48 Individual differences, 146
Feedback Interpersonal relations
group therapy and, 202-203 intimacy and, 19-20
rational-emotive therapy and, 69, 70 older adults, 176-180
Feminist therapy, 135-154 psychoanalysis and, 161-162
applications of self-disclosure in, 148- Interpretation, 98-99
151 Intimacy
equality issues and, 139-141 older adults and, 176-180
Index 293

Intimacy (Cant.) Parenting (Cant.)

psychoanalysis and, 33 transference and, 111-112
psychotherapy and, 3 trust and, 12
reclamation and, 9-10 unconscious and, 109-110
self-disclosure and, 8, 207 Perinatal death, 261-273
shared experience and, 12 fathers' reactions to, 266-267
Intrapersonal self-disclosure, 159 incidence of, 261-262
Irrationality. See Rational-emotive therapy mothers' reactions to, 264-266
self-disclosure barriers, 267-270
Judeo-Christian religious experience. See self-disclosure effects, 271-272
Religious experience unique characteristics of, 262-264
Prejudice, 122-123
Language Projection
ethnic minorities, 123-129 anonymity and, 39-40
Holocaust survivors, 232 transference and, 209-210
self psychology, 80 Psychoanalysis, 31-46
Libido, 112 analyst's self-disclosure, 52-58
Loneliness. See Intimacy anonymity and, 51-52. See also
Anonymity
Minority patients. See Ethnic minorities authoritarian stance and, 110
Modeling, 213-215 blank screen role, 47
Mothering. See Parenting conflict and, 108
Mutual analysis, 35-36 contemporary views of, 37-40
countertransference and, 13
Naive patient fallacy, 98, 99 deficit theory and, 51
Neutrality ethnic minorities and, 130
criticism of, 96 fantasy and, 48
destructive elements of, 112 feminist therapy and, 143
direct affective engagement and, 37 free association and, 8
profile of therapist seeking, 100-101 historical perspective of, 33-36
psychoanalysis and, 39,49-50, 94-95, neutrality and, 49-50
103, 159-160 resistance and, 5-6
self-disclosure and, 99, 207-208, 221 self-disclosure and, 31-33, 93-94, 159-
self psychology and, 95 162
self psychology and, 77
Older adults, 175-189 shared experience and, 3, 9
interpersonal relations and, 176-180 special events and, 41-42, 97
overview of, 175-176 stance summarized, 42-44
patient self-disclosure and, 185-187 therapeutic relationship in, 54-55
psychotherapy and, 180-183 transference and, 48, 103, 104, 111
therapist self-disclosure and, 183-185 unconscious and, 103-104
Outcomes Psychological agency, 121-123
older adults and, 179-180 Psychology of self. See Self psychology
self-disclosure and, 104-106 Psychopathology
alienation and, 9, 10
Parenting description of, 13-14
developmental factors and, 108-109 repression and, 112
effects of, 11 Psychotherapy
Holocaust survivors and, 227, 231, 232 religious experience and, 17
psychoanalysis and, 38-39, 51 spirituality compared, 22-23
religious experience and, 24-25
self psychology and, 78-80, 113-114 Race. See Ethnic minorities
294 Index

Rational-emotive therapy, 61-74 Therapeutic relationship (Cont.)

basics of, 61-62 ethnic minorities and, 117-134. See also
client self-disclosure in, 62-65 Ethnic minorities
obstacles to disclosure in, 71-74 feminist therapy and, 135-154. See also
therapist self-disclosure in, 65-71 Feminist therapy
Reality validation 217-219 group therapy, 191-204. See also Group
Reclamation, 9-10 therapy
Reflection, 8 Holocaust survivors, 227-245. See also
Regression, 112-113 Holocaust survivors
Rejection implicit communication, 93-102. See also
psychoanalysis and, 54 Implicit communication
self-disclosure and, 10 incest, 247-259. See also Incest
Relationships. See Interpersonal intimacy and, 8
relationshi ps older adults, 175-189. See also Older
Relaxation technique, 35, 36 adults
Religious experience, 17-28 parenting and, 24-25
historical perspective on, 17-19 perinatal death and, 261-273. See also
parenting and, 24-25 Perinatal death
preconditions for self-disclosure in, 19- preconditions for, 19-21
21 process of, 25-26
self-disclsoure and, 23-24 progressive views of, 97-99
self-disclosure in practice, 25-26 psychoanalysis and, 31-46, 47, 52-58,
spirituality and, 21-22 159-162. See also Psychoanalysis
spirituality /psychotherapy compared, psychotherapy and, 277-289
22-23 rational-emotive therapy, 61-74. See also
Repression Rational-emotive therapy
neurosis and, 112 rejection fears and, 10
parenting and, 109 religious experience, 17-28. See also Re-
psychoanalysis and 94, 104 ligious experience
Resistance self psychology and, 75-89. See also Self
ethnic minorities and, 123 psychology
generalization of, 277 shared experience and, 3-15
psychoanalysis and, 4, 31 special events, 96-97
psychodynamic parameters of, 5-7 spirituality and, 21-22, 23-24
Role model therapeutic relationship and, 106-107,
children and adolescents' therapy, 170- 114
172 trust and, 9, 10-11
feminist therapy, 142 Self-disclosure criteria, 207-225
analysis of, 220-224
Sadomasochism, 86 autonomy and, 219
Secrets, 8 modeling criteria, 213-215
Seduction theory, 34 overview of, 207-208
Self-disclosure reality validation, 217-219
children and adolescents' therapy, 157- study parameters, 208-209
174. See also Children and adoles- theoretical orientation, 209-210
cents' therapy therapeutic alliance criteria, 215-217
countertransference and, 114-115 therapeutic relationship, 210-212
criteria for, 207-225. See also Self- therapist satisfaction, 220
disclosure criteria therapist self-awareness and, 212
defined, 277 Self-experience. See Self psychology
efficacy and, 104-106 Self-involving disclosure, 158-159
Index 295

Self psychology, 75-89 Self-disclosure (Cont.)

developmental analog in, 77-80 self-disclosure and, 106-107, 114, 210-
developmental factors and, 108-109, 212, 220-224
113-114 self psychology, 79-80
ethnic minorities and, 123 Threat, 7
implications for psychotherapy of, 81- Transference
88 children's therapy, 164
neutrality and, 95-96 direct affective engagement and, 37
psychoanalysis and, 77 empathic stance and, 114
self-disclosure and, 75-77 ethnic minorities and, 130
Sexism, 137 feminist therapy and, 142-143
Sexual abuse. See Incest generalization of, 277
Shared experience group therapy and, 198-199
countertransference and, 13 life situation and, 104, 107
empathy and, 12 parenting and, 111-112
equality and, 11 psychoanalysis and, 4, 48, 94, 95, 103,
intimacy and, 12 104, 111, 160-207
psychoanalysis and, 3 resistance and, 7
self-disclosure and, 3-15 self-disclosure criteria and, 220-221
therapeutic relationship and, 9 special events and, 97
variety of concepts in, 4-5 theoretical orientation and, 209
Silence, 143. See also Neutrality unconscious and, 107-108
Socioeconomic class, 146 Trauma
Sociolinguistics, 124-126. See also psychoanalysis and, 34-35
Language self-disclosure and, 98
Special events, 41-42, 96-97 Trust
Spirituality intimacy and, 20-21
psychotherapy compared, 22-23 parenting and, 12
self-disclosure and, 21-22 self-disclosure and, 9, 10-11
See also Religious experience
Unconscious
Therapeutic alliance, 215-217 parenting and, 109-110
Therapeutic relationship psychoanalysis and, 33, 94, 103-104
ethnic minorities and, 129-130 secrets and, 8
feminist therapy and, 144-145 transference and, 107-108
implicit communication, 93-102
neutrality-seeking therapist profile, Violence, 149, 150
100-101
psychoanalysis and, 54-55, 160-161 Women's movement, 136-137. See also
rational-emotive therapy, 68-69 Feminist therapy