Clinical Psychology Review 30 (2010) 63–77
Contents lists available at ScienceDirect
Clinical Psychology Review
The role of therapist self-disclosure in psychotherapy: A qualitative review
Jennifer R. Henretty ⁎, Heidi M. Levitt 1
University of Memphis, Department of Psychology, 202 Psychology Building, Memphis, Tennessee, 38152-6400, United States
a r t i c l e
i n f o
Article history:
Received 18 February 2009
Received in revised form 7 September 2009
Accepted 14 September 2009
Keywords:
Self-disclosure
Psychotherapy process
Psychotherapy guidelines
a b s t r a c t
Over 90% of therapists self-disclose to clients (Mathews, 1989; Pope, Tabachnick, & Keith-Spiegel, 1987;
Edwards & Murdock, 1994), however, the implications of therapist self-disclosure are unclear, with highly
divergent results from one study to the next. The goal of this paper was to review the empirical literature
relevant to therapist self-disclosure, and provide the reader with a comprehensive understanding of the
factors that affect, and are affected by, therapist self-disclosure. Findings are organized into an integrated
model examining the who, what, when, why, and how of therapist self-disclosure. In addition, training
implications and suggestions for future research are provided.
© 2009 Elsevier Ltd. All rights reserved.
Contents
1.
Review of the quantitative research . . . . . . . . . . . . . . . . . . . . . . . . . .
1.1.
Independent variables in the therapist self-disclosure research . . . . . . . . . .
1.1.1.
Independent variables related to the therapist . . . . . . . . . . . . .
1.1.2.
Independent variables related to the client and/or therapeutic process .
1.1.3.
Independent variables related to issues of diversity . . . . . . . . . . .
1.2.
Dependent variables in the therapist self-disclosure research . . . . . . . . . .
1.2.1.
Dependent variables related to the therapist . . . . . . . . . . . . . .
1.2.2.
Dependent variables related to the client and/or the therapeutic process
1.2.3.
Dependent variables related to client self-disclosure . . . . . . . . . .
1.3.
Types of therapist self-disclosure . . . . . . . . . . . . . . . . . . . . . . . .
1.4.
Self-disclosure versus nondisclosure . . . . . . . . . . . . . . . . . . . . . .
2.
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.1.
Research implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.2.
Training implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.3.
Clinical implications: Synthesizing the research and the theory . . . . . . . . .
2.3.1.
Nondisclosure is no longer the easy answer . . . . . . . . . . . . . .
2.3.2.
Therapists need to consider the issue now . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Although Sidney Jourard was not credited with being the first to use
the term ‘self-disclosure’ until 1958 (Gallucci, 2002), the debate about
its use in psychotherapy had been ongoing for decades. Sigmund Freud
conceived the first model of the ideal therapist stance, likening the
⁎ Corresponding author.
E-mail addresses: [email protected] (J.R. Henretty),
[email protected] (H.M. Levitt).
1
Tel.: +1 901 678 5489; fax: +1 901 678 4518.
0272-7358/$ – see front matter © 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.cpr.2009.09.004
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therapist to a blank screen. “The [therapist] should be opaque to his
patients and, like a mirror, should show them nothing but what is
shown to him” (Freud, 1912/1958, p. 118). Thus, traditional psychoanalysts believed their goal as therapists was to remain a neutral and
anonymous medium, upon which patients could project transference
distortions for the purpose of interpretation.
Conversely, the prodisclosure argument was developed within a
humanistic framework. In the late 1950s, Rogerians were the first
clinicians to adopt practices of therapist self-disclosure (Farber,
2006). Since then, client-centered therapists continually have argued
64
J.R. Henretty, H.M. Levitt / Clinical Psychology Review 30 (2010) 63–77
that by cautiously modeling openness, strength, vulnerability, and the
sharing of intense feelings, the therapist who uses therapy-relevant
self-disclosure invites the client to follow the lead and cultivates trust,
perceived similarity, credibility, and empathic understanding (Kottler,
2003; Knox, Hess, Petersen, & Hill, 1997). Furthermore, feminist and
multicultural therapeutic approaches have since placed a premium on
therapist self-disclosure (Brown & Walker, 1990; Mahalik, Van Ormer,
& Simi, 2000).
While the zeitgeist ever-changes and the debate continues, we
know that therapists are self-disclosing. Although therapist selfdisclosure is one of the rarest techniques, comprising an estimated
average of 3.5% of therapist interventions (Hill & Knox, 2002), over 90%
of therapists report that they have self-disclosed in therapy (Edwards
& Murdock, 1994; Mathews, 1989; Pope, Tabachnick, & Keith-Spiegel,
1987). However, contradictory empirical findings and theoretical
conceptualizations, teamed with ambiguous ethical guidelines
(Domenici, 2006) and little to no training as to the nature and use of
therapist self-disclosure (Beutler, Crago, & Arizmendi, 1986), may
leave therapists feeling vulnerable and anxious about self-disclosing
(Hill & Knox, 2002; Knox & Hill, 2003). Practitioners need a more
coherent understanding of therapist self-disclosure so that they can
weigh the pros and cons of its use, and, when deemed therapeutically
appropriate, use this technique with confidence. Therefore, this paper
aims to review the quantitative research pertaining to therapist selfdisclosure and, in the Discussion section, synthesize those findings
with the relevant theoretical literature into an integrated model
examining the who, what, when, why, and how of therapist selfdisclosure. In addition, training implications and concrete suggestions
on how to address gaps and inconsistencies in the literature with
future research will be provided.
1. Review of the quantitative research
A perusal of the relevant literature suggests that, despite the many
writings supporting judicious therapist self-disclosure, some authors
remain concerned with clinical ramifications of such disclosure; that is,
they question whether therapist disclosure is a therapeutically helpful
intervention (Peterson, 2002). This paper reviews quantitative results of
published research on verbal therapist self-disclosure via summaries
and, when the research body consists of five or more studies, via tables.
Note that every study included in this review is examined in terms of
variables (e.g., client perceptions, therapist orientation) and types of
comparisons (e.g., disclosure vs. nondisclosure, positive self-disclosure
vs. negative self-disclosure) that it utilizes, thus some studies are
necessarily referenced in multiple summaries and tables. The empirical
review will be divided into the following sections: (a) studies examining
the relationship between various independent variables and therapist
self-disclosure, (b) studies examining the relationship between various
dependent variables and therapist self-disclosure, (c) studies comparing
types of therapist self-disclosure, and (d) studies comparing disclosure
to nondisclosure.
1.1. Independent variables in the therapist self-disclosure research
This section is subdivided into independent variables associated
with the therapist, which tend to be demographic (e.g., education,
theoretical orientation, professional status, age), and independent
variables associated with the client (such as client demographic or
diagnostic variables) or with the therapeutic process (i.e., alliance, as
it affects disclosure). A third subsection discusses independent
variables associated with issues of diversity, consisting of gender,
ethnicity, and sexual orientation.
1.1.1. Independent variables related to the therapist
When examining the relationship between frequency, or use, of
therapist self-disclosure and therapist-related independent variables,
this review found no correlation with therapists' age (Berg-Cross, 1984)
or with therapists' level of education (Andersen & Anderson, 1989;
Simone, McCarthy, & Skay, 1998). Studies that attempted to discern,
using analogue methodology (i.e., using non-client samples in situations
designed to be similar to the therapy experience), whether and how
therapists' professional status interacts with therapist self-disclosure on
clients' perception and responses, had inconsistent results: One study
found that professional status had no main or interaction effect on clients
responses and perceptions (McCarthy, 1982); one study's findings
implied that it may be more important for professional therapists to selfdisclose than non-professional therapists (Merluzzi, Banikiotes, &
Missbach, 1978); and one study's finding implied that paraprofessional
therapists should self-disclose intimately, whereas professional therapists should utilize non-intimate self-disclosures (Simonson & Bahr,
1974). Because each study examined different types of therapist selfdisclosure and only one used a no disclosure control, results cannot
meaningfully be aggregated across studies.
When the relationship between therapist self-disclosure and amount
of clinical experience is examined (see Table 1), results across studies
were inconsistent. However, it seems that early-career therapists may
disclose less and for different reasons (e.g., to prevent client from
questioning therapist's mental health; Simone et al., 1998) than more
experienced therapists, but that the frequency of self-disclosure plateaus
at some point for female therapists, showing little difference between
therapists with an intermediate amount of experience and more. For
male therapists, self-disclosure may decrease as experience is gained
past an intermediate amount.
Therapists of differing theoretical orientations have different views
on the utility and appropriateness of therapist self-disclosure (Peterson,
2002; Williams & Levitt, 2008). However, results of surveys that
examined use of therapist self-disclosure and theoretical orientation
(i.e., Andersen & Anderson, 1989; Berg-Cross, 1984; Edwards &
Murdock, 1994; Simi & Mahalik, 1997) did not consistently show
differences among the various orientations. Two surveys reported no
relationship (Andersen & Anderson, 1989; Berg-Cross, 1984), whereas
one survey (Edwards & Murdock, 1994) reported that psychoanalytic/
psychodynamic therapists utilized less therapist self-disclosure than
Table 1
Does clinical experience affect amount of therapist self-disclosure (TSD)? (6).
Possible Studies
answers
Yes (3)
No (3)
Andersen and Anderson (1989): SV — therapists
with 1 year of experience or less reported disclosing
significantly less than therapists with 2–5 years and
10+ years experience
Robitschek and McCarthy (1991): SV — for male
therapists, more experience correlated with less TSD
Berg-Cross (1984): SV
Summary
Barrett and Berman (2001): EX — when therapists
were instructed to increase their use of TSD,
experienced therapist increased their TSD
significantly more than less experienced therapists
RESULTS MIXED but, if a relationship exists, it may be
non-linear, with therapists with only the least (and,
possibly, for male therapists, the most) amount of
clinical experience disclosing less
Simi and Mahalik (1997): EX
Simone et al. (1998): SV
Note. The numbers in parentheses indicate how many studies contributed to that question or possible answer. SV = survey; EX = experiment.
J.R. Henretty, H.M. Levitt / Clinical Psychology Review 30 (2010) 63–77
other therapists, and one survey (Simi & Mahalik, 1997) found
differences between psychoanalytic/psychodynamic and therapists of
other orientations use of different types of, and reasons for, therapist
self-disclosures. Although results were mixed, if there is a difference
among therapists from various theoretical orientations, it appears that
therapists from psychoanalytic and psychodynamic theories may
disclose less, but that the difference may not be as large as theorized.
1.1.2. Independent variables related to the client and/or therapeutic
process
The studies reviewed in this paper examined the following
independent client-related variables as they relate to therapist selfdisclosure: age, diagnosis/type of disorder, symptomatology, and
expectation of disclosure. Overall, results suggested that neither
clients' age (Myers & Hayes, 2006; Simone et al., 1998), nor clients'
expectation of therapist self-disclosure (Derlega, Lovell, & Chaikin,
1976; Peca-Baker & Friedlander, 1987; VandeCreek & Angstadt, 1985),
had an interaction effect with therapist self-disclosure on clients'
perceptions of, or responses to, the therapist. However, client
diagnosis/type of disorder and therapist self-disclosure were shown
to have a relationship, with therapists disclosing least to clients
diagnosed with personality disorders (Mathews, 1989) or having
weak ego-strength (Simone et al., 1998). Only one study examined
clients' symptomatology in relation to therapist self-disclosure (Kelly
& Rodriguez, 2007). It found that therapists self-disclosed more to
clients with lower pre-therapy symptomatology. The only therapyrelated independent variable investigated was alliance. The one study
that examined alliance as an independent variable found that
analogue clients with a strong therapeutic alliance perceived a selfdisclosing therapist more favorably than clients with a weak alliance
and a disclosing therapist (Myers & Hayes, 2006).
1.1.3. Independent variables related to issues of diversity
Although few studies examined issues of diversity as they relate to
therapist self-disclosure, this distinction seemed important, especially
given that feminist and multicultural therapists tend to advocate the use
of therapist self-disclosure to reduce the power imbalance between
therapists and clients, to decrease clients' feelings of shame, and to
transmit feminist values from therapists to clients (Brown, 1994;
Mahalik et al., 2000). Therefore, this subsection examines issues of
sexual orientation, ethnicity, and gender.
Only two studies examined the topic of sexual orientation as it
pertains to therapist self-disclosure. One survey found that therapists
of a feminist theoretical orientation were more likely to disclose their
sexual orientation to clients than therapists of all other theoretical
orientations (Berg-Cross, 1984). An analogue experiment by Atkinson,
Brady, and Casas (1981) found that gay men rated male therapists
who self-disclosed a gay sexual orientation more favorably than male
therapists who did not disclose or disclosed a heterosexual orienta-
65
tion, but that there was no difference between ratings of male
therapists who did not disclose and those that disclosed heterosexual
orientations. Due to diversity in research methodology, results across
the two studies cannot be aggregated; however, it may be that selfdisclosing only makes a difference–that difference being positive–
when the therapist and client are both of a minority sexual orientation
(Atkinson et al., 1981).
Two studies (Edwards & Murdock, 1994; Myers & Hayes, 2006)
coded for ethnicity (see Table 2) and found no differences among
ethnic groups on clients' perceptions and responses to therapist selfdisclosure. However, these studies had a relatively homogenous,
mostly Caucasian sample. Six other studies specifically investigated
ethnicity as it related to therapist self-disclosure with more varied
samples, with three examining the effect of Mexican or MexicanAmerican culture, two examining the effect of African-American/Black
culture, and one examining the effect of Asian-American culture.
Although the number of studies is too few to be able to understand
conclusively the particular effects each culture had on the impact of
therapist self-disclosure, the results of the studies suggest that culture
may interact with therapist self-disclosure.
Studies that examined therapist self-disclosure and client gender,
therapist gender, and/or gender pairing in the therapeutic dyad were
compiled (see Table 3). Of all the diversity variables reviewed, it
appears that only gender–of the client, therapist, and dyad–produced,
in general, reliable results. Specifically, neither client gender, nor
therapist gender, nor gender pairing, affected how much a therapist
self-disclosed to a client. Additionally, gender did not reliably have an
interaction effect with therapist self-disclosure on clients' perceptions
of, and responses to, disclosing and nondisclosing therapists.
1.2. Dependent variables in the therapist self-disclosure research
This section is subdivided into three parts. The first subsection
discusses articles that examined dependent variables associated with
therapists. The therapist-related dependent variables in the literature
tend to be ratings of the therapist's demeanor and performance in
therapy. The second subsection investigates dependent variables
related to clients (such as clients' feelings toward the therapist) or
the process of therapy (such as alliance, as it is affected by disclosure).
The third subsection reviews studies that investigated variables
related to client self-disclosure. The division of this section (dependent
variables) into these three subsections (therapist-related dependent
variables, client-related dependent variables, and dependent variables
related to client self-disclosure) is indicative of the distinction among
clients' perceptions–that is, client ratings of which the therapist is the
subject (e.g., “my therapist is attractive”); clients' feelings–that is,
client ratings of which the client is the subject (e.g., “I am attracted to
my therapist”); and client disclosure measures–ratings which, except
in the case of client willingness to disclose, are done by someone other
Table 2
Is there a relationship between client ethnicity and therapist self-disclosure (TSD)? (8).
Possible
answers
Studies
Yes (4)
Cashwell, Shcherbakova, and Cashwell (2003): ASV — clients
indicated preference for TSD when therapist was of different
ethnicity; African-American clients indicated higher
preference for TSD than Caucasian clients about personal
feelings, sexual and professional issues, and success/failure
Cherbosque (1987a): ASV — American clients expected
more TSD than Mexican clients
Borrego, Chavez, and Titley (1982): AQEX —
Mexican-American vs. Anglo-American
Edwards and Murdock (1994): SV — Caucasian vs.
non-Caucasian
No (4)
Summary
Wetzel and Wright-Buckley (1988): AEX — Black
clients paired with Black therapists showed
preference to high TSD therapy condition;
Black clients paired with White therapists showed
preference to low TSD therapy condition
Cherbosque (1987b): AEX — Mexicans showed
preference for No TSD therapy; Americans did not
Kim et al. (2003): AQEX — Asian values
RESULTS MIXED, but, if a relationship exists,
clients of Mexican cultures may prefer
nondisclosure, whereas African-American/
Black clients may prefer TSD
Myers and Hayes (2006): AEX — general ethnicity
Note. The numbers in parentheses indicate how many studies contributed to that question or possible answer. SV = survey; ASV = analogue survey; AEX = analogue experiment;
AQEX = analogue quasi-experiment.
66
J.R. Henretty, H.M. Levitt / Clinical Psychology Review 30 (2010) 63–77
Table 3
Gender and therapist self-disclosure (TSD).
Possible answers
Studies
Summary
Is there a relationship between client gender and TSD? (21)
Yes (7)
Hendrick (1988): ASV — male clients endorsed greater
interest in TSD of sexual material than female clients
Davis and Skinner (1974): AEX — in TSD group, male clients'
disclosure imitation (of TSD) was greater than female clients'
Feigenbaum (1977): AEX — male clients disclosed more
intimately in TSD group; female clients in no TSD group
Cherbosque (1987a): ASV — male clients expected more TSD
No (14)
Borrego et al. (1982): AQEX
Cherbosque (1987b): AEX
DeForest and Stone (1980): AEX
Hoffman-Graff (1977): AEX
Lundeen and Schuldt (1989): AEX
Lundeen and Schuldt (1992): AEX
Mallinckrodt and Helms (1986): AQEX
Hendrick (1990): SV — male clients endorsed greater
interest in TSD of sexual material than female clients
Kelly and Rodriguez (2007): SV — therapists disclosed
more to female clients than male clients
Hoffman and Spencer (1977): AEX — female clients
showed preference for negative TSDs, whereas male
clients showed preference for positive TSDs
McAllister and Kiesler (1975): AQEX
Merluzzi et al. (1978): AEX
Myers and Hayes (2006): AEX
Nilsson et al. (1979): AQEX
Perrin and Dowd (1986): AEX
Remer, Roffey, and Buckholtz (1983): AEX
Watkins and Schneider (1989): AEX
No clear relationship
Is there a relationship between therapist gender and TSD? (12)
Yes (4)
Hendrick (1988): ASV — clients desired TSD about sexual
issues from female therapists more than male therapists
Merluzzi et al. (1978): AEX — for female therapists only,
clients preferred low TSD
No (8)
Andersen and Anderson (1989): SV
DeForest and Stone (1980): AEX
Edwards and Murdock (1994): SV
Hoffman-Graff (1977): AEX
Pope et al. (1987): SV — male therapists were more likely
than female therapists to tell clients of their attraction to them
Robitschek and McCarthy (1991): SV — more experienced
male therapists used less TSD than female therapists
Nilsson et al. (1979): AQEX
Simone et al. (1998): SV
Vondracek (1969): AQEX
Watkins and Schneider (1989): AEX
No clear relationship
Is there a relationship between gender pairing and TSD? (5)
Yes (1)
Watkins and Schneider (1989): AEX — male clients preferred positive self-involving (emotions) TSDs from a male therapist and
negative self-involving TSDs from a female therapist; female clients preferred negative self-involving and positive self-disclosing
(experiences) TSDs from a female therapist, and preferred negative self-disclosing TSDs from a male therapist
No (4)
DeForest and Stone (1980): AEX
Hoffman-Graff (1977): AEX
Goodyear and Shumate (1996): AQEX
McCarthy (1979): AEX
No clear relationship
Note. The numbers in parentheses indicate how many studies contributed to that question or possible answer. SV = survey; ASV = analogue survey; AEX = analogue experiment;
AQEX = analogue quasi-experiment.
than the client. Note, however, that each subsection pertains to the
impact therapist self-disclosure has on clients.
1.2.1. Dependent variables related to the therapist
The studies reviewed in this paper examined the following eight
therapist-related, dependent variables (see Table 4): expertness, trustworthiness, attractiveness, level of regard, empathy, congruence, unconditionality, and warmth. Across studies, results point to therapist selfdisclosure having no reliable effect on how clients perceived their
therapists on the five qualities of trustworthiness, level of regard,
empathy, congruence, and unconditionality. However, clients reliably
perceived therapists who self-disclosed as warmer.
Although results were not as reliable for the effect therapist selfdisclosure had on ratings of therapist expertness and therapist
attractiveness, trends were discerned with each variable. Related to
client ratings of therapist expertness, the pattern of results suggested
that therapist self-disclosure most likely has no significant effect on
perceptions of expertness; however, if disclosure does have an effect
on the variable of expertness, its effect may be negative, with
disclosing therapists perceived as less expert than nondisclosing
therapists. Related to client ratings of therapist attractiveness, the
trend suggested that therapist self-disclosure had either no effect or a
positive effect on therapists' attractiveness—results from only 1 of 20
studies suggested that therapists who self-disclosed were perceived
by clients as less attractive than nondisclosing therapists. In summary
of this amalgamated research, therapist self-disclosure reliably had no
significant effect, either positive or negative, on five variables
(trustworthiness, level of regard, empathy, congruence, and unconditionality), reliably had a positive effect on one variable (warmth),
had either no effect or a positive effect on one variable (attractiveness), and had either no effect or a negative effect on one variable
(expertness).
1.2.2. Dependent variables related to the client and/or the therapeutic
process
The studies reviewed in this paper examined the following
dependent client-related variables: alliance/relationship; change in
problems (or clients' perception of problems)/symptom distress;
willingness to return/see a similar therapist/refer a friend; and clients'
attraction to, and liking for, the therapist. Two studies examined the
alliance/therapeutic relationship as it relates to therapist self-disclosure:
One survey (Kelly & Rodriguez, 2007) found that therapist selfdisclosure was not significantly related to scores on the Working
Alliance Inventory, as rated by both therapists and clients. One analogue
quasi-experiment (i.e., an analogue experiment that did not utilize
random assignment; VandeCreek & Angstadt, 1985) found that
analogue clients rated their relationship higher with disclosing
therapists than nondisclosing therapists, even when those clients had
a low preference and low anticipation for therapist self-disclosure. Thus,
across these two studies, results were inconsistent.
Similarly, results across studies for the variable of change in clients'
perception of their problems/symptom distress, as it relates to therapist
self-disclosure, could not be meaningfully aggregated. Two analogue
experiments examined the impact of valence of therapist self-disclosure
(positive vs. negative therapist self-disclosures) on change in clients'
problems/perception of problems: One study (Hoffman & Spencer,
1977) found that analogue clients in the positive therapist selfdisclosure condition experienced significantly more positive change in
their problem (procrastination) than those in the negative disclosure
condition, whereas the other study (Hoffman-Graff, 1977) found that
analogue clients in the negative therapist self-disclosure condition
experienced significantly more positive change in their perception of
their problem (procrastination) than those in the positive disclosure
condition. Furthermore, one survey (Kelly & Rodriguez, 2007) found
that therapist self-disclosure was not significantly related to symptom
J.R. Henretty, H.M. Levitt / Clinical Psychology Review 30 (2010) 63–77
67
Table 4
Dependent variables related to the therapist: Clients' perceptions of therapists and therapist self-disclosure (TSD).
Possible answers
Studies
Does TSD affect clients' perception of therapists' expertness? (18)
Yes, positively (1)
VandeCreek and Angstadt (1985): AQEX
Yes, negatively (5)
Carter and Motta (1988): AQEX
Cherbosque (1987b): AEX
Curtis (1982): AEX
No clear effect or mixed
Dowd and Boroto (1982): AEX
results within study (9) Lundeen and Schuldt (1989): AEX
Lundeen and Schuldt (1992): AEX
Mallinckrodt and Helms (1986): AQEX
Myers and Hayes (2006): AEX
Other results (3)
McCarthy (1979): AQEX — higher expertness
ratings for self-involving (emotions) TSD condition
than self-disclosing (experiences) TSD condition
McCarthy (1982): AQEX — higher expertness
ratings for TSD of/with feelings
than TSD not related to feelings
Does TSD affect clients' perception of therapists' trustworthiness? (19)
Yes, positively (1)
Lundeen and Schuldt (1989): AEX
Yes, negatively (2)
Cherbosque (1987b): AEX
Carter and Motta (1988): AQEX
No clear effect or mixed
Doster and Brooks (1974): AEX
results within study
Dowd and Boroto (1982): AEX
(13)
Goodyear and Shumate (1996): AQEX
Loeb and Curtis (1984): AEX
Lundeen and Schuldt (1992): AEX
Mallinckrodt and Helms (1986): AQEX
Other results (3)
McCarthy (1979): AQEX — higher trustworthiness
ratings for self-involving TSDs than
self-disclosing TSDs
McCarthy (1982): AQEX — higher trustworthiness
ratings for TSD of/with feelings than TSD
not related to feelings
Does TSD affect clients' perception of therapists' attractiveness? (20)
Yes, positively (8)
Dowd and Boroto (1982): AEX
Fox, Strum, and Walters (1984): AQEX
Goodyear and Shumate (1996): AQEX
Lundeen and Schuldt (1989): AEX
Yes, negatively (1)
Carter and Motta (1988): AQEX
No clear effect or mixed
Cherbosque (1987b): AEX
results within study (9) Hoffman-Graff (1977): AEX
Klein and Friedlander (1987): AEX
McCarthy (1982): AEX
McCarthy and Betz (1978): AEX
Other results (2)
Watkins and Schneider (1989): AEX — positive
self-involving TSD rated more attractive than
negative self-involving
Does TSD affect clients' perception of therapists' level of regard? (7)
No clear effect or mixed
Borrego et al. (1982): AQEX
results within study (6) Giannandrea and Murphy (1973): AEX
Hoffman and Spencer (1977): AEX
Other results (1)
Hoffman-Graff (1977): AEX — negative past TSDs
got higher ratings for regard than positive TSDs
Summary
Goodyear and Shumate (1996): AQEX
Merluzzi et al. (1978): AEX
Peca-Baker and Friedlander (1987): AEX
Peca-Baker and Friedlander (1989): AEX
Perrin and Dowd (1986): AEX
Watkins and Schneider (1989): AEX
No clear effect, but, if a relationship exists,
therapists who self-disclose may be perceived
as less expert than therapists who do not;
additionally, therapists who self-disclose
about their intratherapy feelings may be
perceived as more expert than therapists
who disclose extratherapy facts
McCarthy and Betz (1978): AEX — higher
expertness ratings for self-involving TSD
condition than self-disclosing TSD condition
Merluzzi et al. (1978): AEX
Myers and Hayes (2006): AEX
Peca-Baker and Friedlander (1987): AEX
Peca-Baker and Friedlander (1989): AEX
Perrin and Dowd (1986): AEX
Watkins and Schneider (1989): AEX
Wetzel and Wright-Buckley (1988): AEX
NO, TSD does not have a clear effect on
clients' perception of the therapists'
trustworthiness; however, therapists
who self-disclose about their intratherapy
feelings may be perceived as more
trustworthy than therapists who
self-disclose extratherapy facts
McCarthy and Betz (1978): AEX — higher
trustworthiness ratings for self-involving TSD
condition than self-disclosing TSD condition
Lundeen and Schuldt (1992): AEX
Mallinckrodt and Helms (1986): AQEX
Merluzzi et al. (1978): AEX
Peca-Baker and Friedlander (1987): AEX
RESULTS MIXED, but, if a relationship exists,
therapists who self-disclose may be perceived
as more attractive than therapists who do not
Myers and Hayes (2006): AEX
Peca-Baker and Friedlander (1989): AEX
Perrin and Dowd 1986): AEX
Reynolds and Fischer (1983): AEX
McCarthy (1979): AQEX — self-involving
therapist rated more attractive than
self-disclosing therapist
Klein and Friedlander (1987): AEX
Mann and Murphy (1975): AEX
Peca-Baker and Friedlander (1989): AEX
Does TSD affect clients' perception of therapists' empathy? (14)
Yes, positively (1)
Murphy and Strong (1972): AEX
Yes, negatively (2)
Carter and Motta (1988): AQEX
No clear effect or mixed
Borrego et al. (1982): AQEX
results within study (8) Giannandrea and Murphy (1973): AEX
Hoffman and Spencer (1977): AEX
Loeb and Curtis (1984): AEX
Other results (3)
Hoffman-Graff (1977): AEX —negative past TSDs
got higher ratings for empathy than positive TSDs
Klein and Friedlander (1987): AEX — negative TSDs
were rated higher on empathy than positive TSDs
Curtis (1982): AEX
Mann and Murphy (1975): AEX
Merluzzi et al. (1978): AEX
Peca-Baker and Friedlander (1987): AEX
Peca-Baker and Friedlander (1989): AEX
Nilsson et al. (1979): AQEX — self-involving
TSD therapists were rated higher on
understanding than self-disclosing TSD
therapists
Does TSD affect clients' perception of therapists' congruence? (7)
No clear effect or mixed
Borrego et al. (1982): AQEX
results within study (7) Giannandrea and Murphy (1973): AEX
Hoffman and Spencer (1977): AEX
Hoffman-Graff (1977): AEX
Mann and Murphy (1975): analogue
experiment
Peca-Baker and Friedlander (1987): AEX
Peca-Baker and Friedlander (1989): AEX
NO, TSD does not have a clear effect on
clients' perception
of the therapists' level of regard
NO, TSD does not have a clear effect on
clients' perception
of the therapists' empathy
NO, TSD does not have a clear effect on
clients' perception
of the therapists' congruence
(continued on next page)
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Table 4 (continued)
Possible answers
Studies
Summary
Does TSD affect clients' perception of therapists' unconditionality? (7)
Yes, negatively (1)
Curtis (1982): AEX
No clear effect or mixed
Borrego et al. (1982): AQEX
results within study (5) Giannandrea and Murphy (1973): AEX
Hoffman-Graff (1977): AEX
Other results (1)
Hoffman and Spencer (1977): AEX —negative
TSD therapist received higher ratings on
unconditionality of regard
Mann and Murphy (1975): AEX
Peca-Baker and Friedlander (1989): AEX
Does TSD affect clients' perception of therapists' warmth? (5)
Yes, positively (3)
Fox et al. (1984): AQEX
Nilsson et al. (1979): AQEX
Murphy and Strong (1972): AEX
No clear effect (1)
Doster and Brooks (1974): AEX
Other results (1)
Reynolds and Fischer (1983): AEX — no
differences or interactions were found for negative
vs. positive or self-involving vs. self-disclosing TSD
on warmth ratings
NO, TSD does not have a clear effect on
clients' perception
of the therapists' unconditionality
YES, TSD affects clients' perception of
the therapists' warmth; therapists who SD
were perceived as warmer
Note. The numbers in parentheses indicate how many studies contributed to that question or possible answer. SV = survey; ASV = analogue survey; AEX = analogue experiment;
AQEX = analogue quasi-experiment.
change, whereas the results of one naturalistic experiment (Barrett &
Berman, 2001) found that an increase in therapist self-disclosure caused
a decrease in client symptomatology.
Findings of studies that examined clients' willingness to return, see a
similar therapist, or refer a friend to the therapist (see Table 5) were also
mixed. However, it appears that if therapist self-disclosure affected
analogue clients' willingness to see or refer the therapist, it affected it
positively, with clients more willing to see or refer self-disclosing
therapists. In other words, although it is hard to discern if self-disclosure
had a positive effect or no effect, it is clear that self-disclosure did not
have a negative effect—clients did not indicate less willingness to see or
refer the disclosing therapist versus the nondisclosing therapist. Finally,
results generally indicated that analogue clients tended to like therapists
who self-disclosed more than those that did not and those that did less
(see Table 5).
1.2.3. Dependent variables related to client self-disclosure
Known as the dyadic effect (Jourard, 1964), research (e.g., Jourard,
1959; Jourard & Landsman, 1961; Jourard & Richman, 1963) has shown
that disclosure from one person to another often begets reciprocal
disclosure from the receiver. As one of Jourard's founding tenants of selfdisclosure, many studies examined variables related to the possible
dyadic effect of therapist self-disclosure (see Table 6). These variables
include client self-disclosure, willingness of clients to self-disclose, and
intimacy of client self-disclosure. Examining actual client disclosure,
results across studies suggested that clients exposed to therapist self-
disclosure, especially when it was infrequent and of low to moderate
intimacy, self-disclosed more than clients exposed to no therapist selfdisclosure. Results across studies were mixed for other variables related
to client self-disclosure.
1.3. Types of therapist self-disclosure
For the studies that examined different types of self-disclosure
(positive vs. negative, self-involving vs. self-disclosing, more intimate
vs. less intimate), the only distinction that reliably seemed to affect
clients was that of self-involving versus self-disclosing therapists'
disclosures (see Table 7). First posited by McCarthy and Betz (1978), a
self-involving communication “requires the counselor to express his or
her immediate feelings about or reactions to the client” (p. 255),
whereas a self-disclosing communication often is about a therapist's
personal experience and does not refer directly to the client. According
to most of the studies reviewed here, self-involving statements elicited
more positive responses from clients in action and in ratings of their
perceptions of the therapist than self-disclosing statements.
1.4. Self-disclosure versus nondisclosure
Thirty studies that examined nondisclosure or used a control
group of no disclosure were compiled (see Table 8). Of those 30
studies, 20 had results that favored the use of therapist self-disclosure,
whereas only 4 studies had results that suggested therapist self-
Table 5
Dependent variables related to the client and/or the therapeutic process.
Possible answers
Studies
Summary
Does therapist self-disclosure (TSD) affect clients' willingness to return, see a similar therapist, or refer a friend to therapist? (7)
Yes, positively (2)
Fox et al. (1984): AQEX
Merluzzi et al. (1978): AEX
No clear effect or mixed results (4)
Borrego et al. (1982): AQEX
Mallinckrodt and Helms (1986): AQEX
Giannandrea and Murphy (1973): AEX
Nilsson et al. (1979): AQEX
Other results (1)
Watkins and Schneider (1989): AEX — clients were
more willing to continue to see therapist that used
positive self-involving TSD than all other types
(negative self-involving and positive and negative selfdisclosing)
Does TSD affect clients' attraction to or liking for the therapist? (5)
Yes, positively (4)
Barrett and Berman (2001): EX
Merluzzi et al. (1978): AEX
No clear effects (1)
Hoffman and Spencer (1977): AEX
Nilsson et al. (1979): AQEX
Simonson and Bahr (1974): AQEX
MIXED RESULTS; however,
if there exists a
relationship, it appears to
be positive
YES, TSD positively affects
clients' attraction to, or
liking for, therapists
Note. The numbers in parentheses indicate how many studies contributed to that question or possible answer. EX = experiment; AEX = analogue experiment; AQEX = analogue
quasi-experiment.
J.R. Henretty, H.M. Levitt / Clinical Psychology Review 30 (2010) 63–77
69
Table 6
Dependent variables related to client self-disclosure (CSD).
Possible answers
Studies
Summary
Does therapist self-disclosure (TSD) affect clients' (actual) self-disclosure? (11)
Yes, positively (7)
Davis and Skinner (1974): AEX
Doster and Brooks (1974): AEX
Jourard and Friedman (1970): AQEX
Powell (1968): AEX
Yes, negatively (1)
Vondracek (1969): AQEX
No clear effect (3)
Barrett and Berman (2001): EX
Lundeen and Schuldt (1992): AEX
Does TSD affect clients' predicted willingness to self-disclosure? (7)
Yes, positively (2)
Bundza and Simonson (1973): AQEX
Yes, negatively (1)
Cherbosque (1987b): AEX
No clear effect or mixed
Borrego et al. (1982): AQEX
results (4)
Lundeen and Schuldt (1992): AEX
Does TSD affect the intimacy of clients' self-disclosure? (5)
Yes, positively (2)
Derlega et al. (1976): AQEX
No clear effect or mixed
Barrett and Berman (2001): EX
results (3)
Feigenbaum (1977): AEX
Mann and Murphy (1975): AEX — moderate frequency YES, moderate TSD elicited more
TSD more than no TSD
client self-disclosure
Simonson (1976): AQEX — moderate intimacy TSD more
than no TSD
Truax and Carkhuff (1965): NOB
Simonson and Bahr (1974): AQEX
Nilsson et al. (1979): AQEX
RESULTS MIXED
Simonson (1976): AQEX
Simonson and Bahr (1974): AQEX
McAllister and Kiesler (1975): AQEX
Vondracek (1969): AQEX
RESULTS MIXED
Note. The numbers in parentheses indicate how many studies contributed to that question or possible answer. EX = experiment; AEX = analogue experiment; AQEX = analogue
quasi-experiment; NOB = naturalistic observation.
disclosure did more harm than good. This ratio, 5:1, of studies that
favored therapist self-disclosure to those that did not, suggested that
self-disclosing therapists elicited more positive responses and
perceptions from clients than therapists who did not disclose.
In summary, a review of the published quantitative studies exploring
verbal therapist self-disclosure suggested that (a) self-disclosure (vs.
nondisclosure) had a positive effect on clients; (b) clients had a stronger
liking for, or attraction to, therapists that self-disclosed; (c) clients
perceived therapists who self-disclosed as warmer; (d) clients selfdisclosed more to therapists that self-disclosed; (e) clients had a more
positive response to self-involving therapist disclosures (thoughts and
feelings about the client) than to self-disclosing therapist selfdisclosures (extratherapy experiences); and (f) therapists were less
likely to self-disclose to clients diagnosed with personality disorders. In
addition, the review suggested that the following variables did not
affect, or were not affected by, therapist self-disclosure: therapists'
education; clients' age; therapists' gender, clients' gender, and gender
pairing; clients' expectation of therapist self-disclosure; clients' perception of therapists' trustworthiness, level of regard, empathy, congruence, and unconditionality; and clients' use of affective words. All other
variables reviewed in this empirical section either had mixed results
across studies or were examined in too few studies for results to be
aggregated meaningfully.
2. Discussion
2.1. Research implications
There are several problems with the research on therapist selfdisclosure to date. The first is that of a definition: Whereas some
researchers have classified any self-revealing statement made by
clinicians as therapist self-disclosure (e.g., Cozby, 1973; Weiner, 1983;
Wheeless, 1976), others have defined various types of self-disclosure,
breaking it into disclosures of low and high intimacy (e.g., Carter &
Motta, 1988), positive and negative information (e.g., Hoffman-Graff,
1977), or intratherapy feelings and extratherapy experience (e.g.,
Reynolds & Fischer, 1983), just to name a few. Multiple definitions of
therapist self-disclosure render meaningful analysis of findings across
studies difficult, if not impossible. Several authors (e.g., Farber, 2006;
Knox et al., 1997; McCarthy; 1979) see a general distinction between
Table 7
Types of therapist self-disclosure.
Possible answers
Studies
Summary
Does the valence of therapist self-disclosure (positive vs. negative) have a differential impact on clients? (7)
Yes, in favor of positive TSD (3)
Berg-Cross (1984): SV
Watkins and Schneider (1989): AEX
Remer et al. (1983): AEX
Yes, in favor of negative TSD (2)
Hoffman-Graff (1977): AEX
Klein and Friedlander (1987): AEX
No differential effect or mixed results (2)
Doster and Brooks (1974): AEX
Hoffman and Spencer (1977): AEX
Does the intimacy of the therapist self-disclosure have a differential impact on clients? (6)
Yes, favoring more intimate TSD (3)
DeForest and Stone (1980): AEX
Derlega et al. (1976): AQEX
Yes, favoring less intimate TSD (2)
Loeb and Curtis (1984): AEX
No differential effect (4)
Carter and Motta (1988): AQEX
Curtis (1982): AEX
Simonson (1976): AQEX
Merluzzi et al. (1978): AEX
Simonson and Bahr (1974): AQEX
Do self-disclosing and self-involving therapist self-disclosures have a differential impact on clients? (8)
Yes, favoring self-involving TSDs (6)
Cherbosque (1987b): AEX
Hill et al. (1989): NOB
McCarthy (1979): AQEX
No differential effect or mixed results (2)
Dowd and Boroto (1982): AEX
McCarthy and Betz (1978): AEX
Nilsson et al. (1979): AQEX
Reynolds and Fischer (1983): AEX
McCarthy (1982): AEX
Wetzel and Wright-Buckley (1988): AEX
RESULTS MIXED
RESULTS MIXED
YES, self-involving
TSD elicited more
positive effects than
self-disclosing TSD
Note. The numbers in parentheses indicate how many studies contributed to that question or possible answer. SV = survey; AEX = analogue experiment; AQEX = analogue quasiexperiment; NOB = naturalistic observation.
70
J.R. Henretty, H.M. Levitt / Clinical Psychology Review 30 (2010) 63–77
Table 8
Does therapist self-disclosure (vs. nondisclosure) have an effect on clients? (30).
Possible answers
Studies
Yes, positively (20)
Bundza and Simonson (1973): AQEX
Davis and Skinner (1974): AEX
Donley, Horan, and DeShong (1989): AEX
Doster and Brooks (1974): AEX
Dowd and Boroto (1982): AEX
Fox et al. (1984): AQEX
Jourard and Friedman (1970): AQEX
Loeb and Curtis (1984): AEX
Lundeen and Schuldt (1989): AEX
Lundeen and Schuldt (1992): AEX
Carter and Motta (1988): AQEX
Cherbosque (1987b): AEX
Borrego et al. (1982): AQEX
Feigenbaum (1977): AEX
Giannandrea and Murphy (1973): AEX
Yes, negatively (4)
No clear effect or mixed
results (6)
Summary
Mann and Murphy (1975): AEX
McAllister and Kiesler (1975): AQEX
Murphy and Strong (1972): AEX
Nilsson et al. (1979): AQEX
Peca-Baker and Friedlander (1987): AEX
Powell (1968): AEX
Robey (1980): AEX
Simonson (1976): AQEX
Simonson and Bahr (1974): AQEX
VandeCreek and Angstadt (1985): AQEX
Curtis (1982): AEX
Vondracek (1969): AQEX
Myers and Hayes (2006): AEX
Peca-Baker and Friedlander (1989): AEX
Perrin and Dowd (1986): AEX
YES, therapists that self-disclosed
elicited more positive responses
from clients than therapists that
did not self-disclose
Note. The numbers in parentheses indicate how many studies contributed to that question or possible answer. AEX = analogue experiment; AQEX = analogue quasi-experiment.
therapist self-disclosures of the external and of the internal, and
future researchers could contribute to the growing knowledge base by
clearly distinguishing therapist disclosures similarly.
A second problem with the extant research on therapist selfdisclosure is that the variable is typically operationalized in terms of
frequency (Hill & Knox, 2002). This line of thought assumes a linear
relationship between disclosures and process and/or outcome, which is
unlikely (Audet & Everall, 2003): “There is no compelling reason to
believe that more disclosures should lead to better outcome. It may even
be that therapist self-disclosure yields its positive effects because it
occurs so infrequently” (Hill & Knox, 2001, p. 416). Qualitative research
by Hill and Knox (2002) found that although clients generally rated
therapist self-disclosures as helpful, there was not a consistent positive
relationship between frequency of disclosure and treatment outcome.
Therefore, it may be important for future researchers to take into
account multiple factors of therapist disclosure, such as intimacy/depth,
duration/breadth, timing, quality, client readiness, and content.
A third, and major, problem with the extant research is the reliance
on analogue methodology. “Analogue studies are problematic because
they are not “experience-near” and thus have limited applicability to
actual therapeutic situations. In essence they decontextualize a
situation in which context exerts a great degree of influence” (Farber,
2006, p. 147). The contrived, single “session” with a non-client student
volunteering for course credit, who reads a transcript or watches a
recorded mock therapy interaction before rating the therapist does not
“capture actual client internal experience of the dynamics of therapist
self-disclosure in genuine therapy settings, nor does it give information about the perceived consequences, if any, of this intervention
on clients in long-term psychotherapy” (Knox et al., 1997, p. 274).
Although analogue research can provide heuristically useful information, future researchers may want to consider utilizing naturalistic
experiments, with real clients, real therapists, and real therapeutic
relationships (see Barrett & Berman, 2001, for an example).
A fourth problem with the extant research is that many researchers
failed to consider situational and contextual variables that may
moderate and/or mediate the link between therapist self-disclosure
and various measures of therapeutic process and outcome (Collins &
Miller, 1994). These factors, to enumerate a few, include whether the
disclosure was of positive versus negative information, whether the
disclosure was similar versus dissimilar to the client's experience,
whether it came before or after a client disclosure, whether it was
volunteered or as a result of a client question, and the client's expectations and preferences:
Although there were not enough data for us to investigate this fact
more fully, different types of clients seemed to react differently to
therapist self-disclosure. Some of these clients were voracious in
their desire for therapist self-disclosure, wishing their therapists had
disclosed more often or even arranging to meet with another client
of the same therapist to share information about the therapist. These
clients seemed to want to merge in some way with their therapists.
Other clients, however, were less desirous of disclosures, worrying at
times that the disclosures blurred the boundaries of the relationship
or distinctly stating that self-disclosures were inappropriate because
they removed the focus from the client and were unprofessional in
their revelations about the therapist. (Knox et al., 1997, p. 282)
Future researchers, therefore, should consider coding or controlling for various situational and context variables.
The final major problem of previous research concerning therapist
self-disclosure is that it is atheoretical (Hill & Knox, 2002). Most of the
major theoretical positions have received less than adequate attention
in the empirical literature. For example, although many position pieces
advocate for therapist disclosure of GLBT (gay, lesbian, bisexual,
transgender) orientation to GLBT clients (see Ball, 1996; Brooks, 1981;
Cabaj, 1996; Cole, 2006; Domenici, 1997, 2006; Frommer, 1994, 1999;
Frost, 1998; Gartrell, 1984, 1992; Herlands, 2006; Isay, 1991, 1996;
Kooden, 1991; Lewes, 1988; Liddle, 1996; Malyon, 1982; Riddle & Sang,
1978; Rochlin, 1982; Satterly, 2006), only one empirical study (Atkinson
et al., 1981) examined this issue directly. Thus, to enable comprehensible synthesis of the theoretical and empirical literature, future
researchers must place greater emphasis on topics such as those
relating to therapist disclosures of past struggles similar to the client, of
extratherapy experiences that may affect therapy, and of values.
Furthermore, although feminist and multicultural therapists have
advocated use of therapist self-disclosure as a means of empowering
minority clients, very little applicable research has been undertaken to
bolster the argument. This area also is ripe for future researchers to
begin to fuse practice and science. Though much research still is needed
to be able to understand the full impact of therapist self-disclosure, this
review has identified implications for training and practice.
2.2. Training implications
During many practitioners' training, therapist self-disclosure is either
taboo or portrayed as a mistake (Pope, Keith-Spiegel, & Tabachnick,
1986). It is no surprise then that many therapists have received little to
no training on the nature of therapist self-disclosure (Beutler et al., 1986;
Burkard, Knox, Groen, Perez, & Hess, 2006; Knox & Hill, 2003). However,
appropriate and effective therapist self-disclosure requires “interpersonal skills such as tact, timing, patience, humility, perseverance, and
sensitivity. These soft skills cannot be learned from a manual. What can
be taught are the precepts, rules, criteria, and cognitive processes that
guide effective clinical decision making [relevant to therapist self-
J.R. Henretty, H.M. Levitt / Clinical Psychology Review 30 (2010) 63–77
disclosure]” (Geller, 2003, p. 543). Graduate programs, where therapistsin-training can role-play and practice these skills under the aid of a
supervisor, make for a safe environment to learn about the technique of
therapist self-disclosure. Furthermore, experts on the subject (e.g., Hill,
in Goode, 2002) have speculated that beginning therapists may selfdisclose too much. Because frequent therapist self-disclosure can have
detrimental therapeutic effects (Giannandrea & Murphy, 1973), training
programs that ignore the issue of therapist self-disclosure inadvertently
may be doing a disservice to clients. Instead, training programs need to
acknowledge that therapists do self-disclose (Mathews, 1989; Pope
et al., 1987; Edwards & Murdock, 1994) and that the technique has both
merits and risks. Student-therapists should be educated as to how to
think through the who, what, why, when, and how of appropriate selfdisclosure.
2.3. Clinical implications: Synthesizing the research and the theory
Therapists will be faced with self-disclosure decisions throughout
their careers. Whether they are asked, at the onset of therapy,
questions pertaining to their theoretical orientation or their beliefs
and values; whether they are faced with an issue in their personal life
that may impact their professional life; whether they realize they
have a history similar or relevant to their client; or whether they hit
an emotional impasse with a client, therapists will have to make
decisions on, not only if they should disclose, but also to whom, what,
when, why, and how. These quandaries lead to the first clinical
implication of this review:
2.3.1. Nondisclosure is no longer the easy answer
Although for decades therapists have sat quietly and comfortably
behind a mask of anonymity, the theoretical and empirical research
suggests that nondisclosure has risks and benefits that need to be
weighed (as does disclosure). Furthermore, although the latest version
of The American Psychological Association's Ethics Code (2002) offers
no explicit guidance on therapist self-disclosure, several of its codes
apply, with the message that therapists can no longer choose nondisclosure without having considered the issue carefully. (For example,
in the passage concerning informed consent to therapy, the codes
require that psychotherapists inform clients as early as is feasible in the
therapeutic relationship about the nature and anticipated course of
therapy, and provide sufficient opportunity for the client to ask questions and receive answers [APA, 2002]). Thus, avoiding all therapist selfdisclosure, in the hope of reducing possible risks, may do a disservice to
clients (Hanson, 2005).
By choosing nondisclosure, therapists can “model attending to
safety, personal limits, and the existence of rules” (Sweezy, 2005,
p. 88). By making explicit their concern and/or discomfort about how a
disclosure might affect their client, therapists are able to engage in an
open dialogue with the client that remains focused on the client, rather
than the therapist (Mallow, 1998). In addition, therapists, in choosing
nondisclosure, maintain safety over their personal information in an
environment that does not offer them the protection of confidentiality
(Maroda, 1991; Sweezy). However, nondisclosure can be “experienced
as rude, hostile, uncaring, sadistic, retaliatory, evasive, or tantalizing,
among an infinite number of other possibilities, positive as well as
negative. From my perspective, therefore, remaining silent here is as
potentially problematic and as potentially toxic as any other response”
(Ehrenberg, 1995, p. 225). Hanson (2005) cautions that the single
most detrimental effect of nondisclosure is to the alliance, and
research supports the conclusion that the therapeutic relationship is
crucial to therapy outcomes (Gatson, 1990; Gelso & Carter, 1985;
Orlinsky & Howard, 1986; Truax & Mitchell, 1971; Wolfe & Goldfried,
1988). Furthermore, in Hanson's qualitative research on the topic,
clients indicated that their therapist's nondisclosure had inhibited
their own disclosure, felt hurtful and destructive to trust, and/or
resulted in their managing of the therapeutic relationship. As an
71
example, one client mentioned that her therapist's unwillingness to
answer questions had triggered feelings of being unloved, evoking
traumatic feelings similar to those she had experienced in childhood.
However, she never mentioned these feelings in therapy because she
felt that, due to her therapist being reserved and distant, there was no
opening to do so (Hanson).
On the other hand, therapist self-disclosure is not an easy answer
either. Although, when asked, clients often indicate they like therapist
self-disclosure and find it helpful (Hill & Knox, 2002), results across
studies are inconsistent (Kelly & Rodriguez, 2007). Though these
discrepancies may be due to problems in method designs, they also
highlight that the impact of therapist disclosure is “highly contextual,
non-linear, and contingent on multiple delivery factors that cannot be
considered in isolation” (Audet & Everall, 2003, p. 229). In addition, it
is important that therapists feel comfortable with their decision to
self-disclose, which leads to the second clinical implication.
2.3.2. Therapists need to consider the issue now
Although many self-disclosure judgments have to be made in the
moment, it is important for therapists to reflect on how they will
formulate their decisions before that moment arises. Peterson (2002)
observed that the opportunity for therapist self-disclosure often occurs
unexpectedly during a session, and that, therefore, it is important for
therapists to give thought to the issue prior to finding themselves in a
position to self-disclose. Davis (2002), echoing this sentiment, noted
that “although reflecting on [self-disclosure] can be very useful in the
moment of contemplating a disclosure or contemplating withholding a
disclosure, it is often impossible to do. In many instances the therapist is
simply too caught up in the [interaction] to become fully aware of it”
(p. 451). In respect to this issue, the following sections will offer
guidelines for therapists to utilize when considering the who, what,
when, why, and how of therapist self-disclosure. These guidelines are
based upon both empirical and theoretical articles, which are cited after
each guideline, and are meant to facilitate consideration and decision
making rather than provide direct answers to questions about therapist
disclosure.
2.3.2.1. To whom. Although there is not always agreement on who are
the better client candidates for therapist self-disclosure, there seems
to be consensus among the theoretical and empirical literature that
some are better than others. These guidelines refer to the types of
client upon which most authors agree. The first guideline is that
therapists should consider using self-disclosure with clients with
whom they have a strong alliance and/or positive relationship (Bishop
& Lane, 2001; Gallucci, 2002; Myers & Hayes, 2006; Rachman, 1998).
Additionally, therapists may want to consider self-disclosing to clients
with whom they are members of the same small community–for
example, a GLBT community or small town–information that clients
may be likely to learn about their therapist outside of therapy (for
further discussion, see Anthony, 1982; Frost, 1998; Kranzberg, 1998;
Miller & Stiver, 1997; Satterly, 2006; Solomon, 1994). The second
guideline is that therapist self-disclosure, generally, is best avoided
with clients with poor boundaries (Epstein, 1994; Goldstein, 1994),
clients that tend to focus on the needs of others rather than their own
needs (Epstein; Goldstein), clients diagnosed with personality
disorders (Mathews, 1988; Simone et al., 1998), and clients with a
weak ego-strength or self-identity (Raines, 1996; Simone et al.).
Additionally, there are clients who simply feel uncomfortable with
their therapist disclosing:
It is important to identify early on those patients who feel burdened
by the responsibilities that accompany knowing about their
therapist's private life. In my experience, they tend to be the same
patients who cannot take in positive feedback about their impact
on people, including therapists, without feeling “intruded upon,”
“invaded,” “penetrated,” or engulfed.” (Geller, 2003, p. 547)
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Geller also pointed out that there are other reasons why clients
may not express interest in their therapists; for example, clients may
be afraid that their curiosity will be experienced as an invasion of their
therapist's privacy or an act of disrespect, and others may have an
unformulated assumption that there are prohibitions or taboos about
asking therapists personal questions. In the face of client differences,
these preceding guidelines may aid therapists in making decisions
concerning to whom to disclose.
2.3.2.2. What. Based on this literature review, the following guidelines
have been designed to assist therapists in considering what types of
information may be most appropriate to be disclosed to clients.
Therapists should consider self-disclosing (a) demographic information,
such as education, theoretical orientation, and professional and marital
status (Edwards & Murdock, 1994; Gallucci, 2002; Hill & Knox, 2001;
Knox & Hill, 2003; Simonson, 1976); (b) feelings and thoughts about the
client and/or the therapeutic relationship (Basescu, 1990; Bridges, 2001;
Broucek & Ricci, 1998; Kiesler & Van Denburg, 1993; Knox & Hill, 2003;
Kohlenberg & Tsai, 1991; Linehan, 1993; Mathews, 1988; McCarthy,
1979; McCarthy & Betz, 1978; McCullough, 2000; Rachman, 1998;
Raines, 1996; Reynolds & Fischer, 1983); (c) therapy mistakes (Geller,
2003; Geller & Farber, 1997; Hanson, 2005); (d) relevant past struggles
that have been successfully resolved (Cabaj, 1996; Knox & Hill; Mathy,
2006; Mulcahy, 1998; Riddle & Sang, 1978); and (e) similarities
between the client and therapist (Atkinson et al., 1981; Audet & Everall,
2003; Berg-Cross, 1984; Hill & Knox, 2001). However, relevant to the
last two points, therapists may want to practice caution when
considering disclosing about their past struggles with addictions or
disorders, even if those struggles are similar to those of their client, and
even if those struggles are successfully resolved. Such disclosures may
produce results that interfere with treatment, such as clients censoring
themselves out of fear they might negatively affect their therapist
(Mallow, 1998) or a sense of competition between client and therapist
(Dilts, Clark, & Harmon, 1997).
One final area where therapists should consider self-disclosing is
that of values. Although authors are not unanimously in agreement
(e.g., Chung & Bemak, 2002), authors increasingly are advocating for
value explicitness (e.g., Client Rights Project, 1998; Doherty, 1995;
Hawkins & Bullock, 1995; Mahalik et al., 2000; Slife, 2003; Slife, Smith,
& Burchfield, 2003; Williams, 2004; Williams & Levitt, 2007a, 2007b),
especially when the therapist's and client's values are in conflict, to
combat the inevitable conversion of the client's values to that of the
therapist's (Bergin, 1991; Beutler, 1979; Beutler & Bergan, 1991; Kelly,
1990; Kelly & Strupp, 1992; Martinez, 1991; Rosenthal, 1955;
Tjeltveit, 1986, 1999). Though therapists may come to different
conclusions on whether or not to disclose their values, and the other
types of information mentioned in this subsection, it is important for
therapists to weigh the positions for themselves.
2.3.2.3. When. Many authors indicated that a client's stage in therapy is
an important factor in therapists' self-disclosure decisions; however,
opinions and practices across authors are inconsistent. For example,
some authors (e.g., Hawkins & Bullock, 1995; Raines, 1996) are
inclined to answer questions about their orientation and values in a
first session because they feel that providing this information is an
ethical obligation that allows the client to be an informed consumer.
Guthrie (2006) noted that clients, especially those belonging to a
minority group, often seek out a therapist with a similar minority
group membership and/or values “in the hope that the pairing will
provide a greater sense of comfort and understanding around issues of
oppression and self-acceptance” (p. 64). With this understanding, Tan
(1996) and Powell and Craig (2006) encouraged therapists to include
value disclosure statements in their consent forms (see Powell & Craig
for examples).
Other reasons therapists self-disclose in the early stages of therapy
include relieving clients' apprehensions (Simon, 1988), building alliance
and rapport (Simon), and being courteous: “Until the therapeutic
alliance and agreements [are] set, the usual social manners [are]
necessary” (Simon, p. 408). Although many authors agreed that
therapist self-disclosure is a useful tool in the early stages of therapy,
some authors (e.g., Audet & Everall, 2003; Geller, 2003) cautioned that
therapist disclosures during the beginning stages of therapy, while
clients are still acclimating to the therapist and to the process of therapy,
should be limited to those of low intimacy. Several authors (e.g., Bishop
& Lane, 2001; Geller; Mitchell & Black, 1995) suggested that, when
paired with therapists who may utilize self-disclosure at some point in
therapy, clients should be given that expectation explicitly or through
one or more minor therapist disclosures early in treatment. “Patients
[should] be informed from the beginning that the therapist or analyst
may at times reveal his or her own thoughts and feelings for the purpose
of advancing the analytic work. In this way patients are prepared for
what could be a potential shock” (Bishop & Lane, p. 252). This notion is
in line with Derlega and colleagues' (1976) stance that negative
reactions to therapist self-disclosure are a result of therapists failing to
meet client expectations for appropriate therapist behavior. However, it
should be noted that studies by Peca-Baker and Friedlander (1987) and
VandeCreek and Angstadt (1985) did not find that client expectation of
therapist self-disclosure affected the responses or perceptions of
analogue clients.
After the initial stage of therapy, some authors report using less
frequent and/or less intimate self-disclosure (e.g., Dewald, 1982;
Grunebaum, 1993), whereas other report using more (e.g., Audet &
Everall, 2003). During the termination stage of therapy, many
therapists increase their use of self-disclosure to encourage separateness by showing their realness as a person (Geller, 2003; Knox & Hill,
2003; Mathews, 1988); to debrief, discuss, and demystify the process
of therapy (Greene & Geller, 1981; Hill, Mahalik, & Thompson, 1989;
Knox & Hill); and to “celebrate the achievement of these goals, to
reciprocate the tender feelings expressed by an appreciative patient,
and to say good-bye” (Geller, p. 552). For these reasons, therapist selfdisclosure may facilitate termination.
2.3.2.4. Why. When therapists choose to self-disclose, it is crucial that
they do so with a clear rationale. This subsection will present various
empirically and/or theoretically supported rationales for therapist
self-disclosure. However, the major guideline as to the why of
therapist self-disclosure is simply that the therapist have appropriate
reasons to do so—such as those mentioned in this subsection.
One rationale for therapist disclosure is the belief that it is an
ethical obligation (see When section). Other appropriate reasons for
therapists to self-disclose are (a) to promote client disclosure (Bundza
& Simonson, 1973; Jourard, 1964, 1971; Mann & Murphy, 1975; Miller,
1983; Nilsson, Strassberg, & Bannon, 1979; Simonson, 1976); (b) to
foster the therapeutic relationship/alliance (Andersen & Anderson,
1989; Anderson & Mandell, 1989; Berg-Cross, 1984; Curtis, 1981;
Hanson, 2005; Hill & Knox, 2001; Mahalik et al., 2000; Miller; Simon,
1988; Vamos, 1993; VandeCreek & Angstadt, 1985); (c) to model for
clients (Cabaj, 1996; Curtis; Hill & Knox, 2001; Mathy, 2006; Riddle &
Sang, 1978; Simon; Vamos); (d) to encourage clients' autonomy
(Simon; Vamos); (e) to facilitate client self-exploration and selfrevelation (Bundza & Simonson; Jourard 1971; Powell, 1968; Truax &
Carkhuff, 1965), especially around interpersonal patterns (Bridges,
2001; Kohlenberg & Tsai, 1991; Linehan, 1993; McCullough, 2000);
(f) to validate reality (Hill & Knox, 2001; Mathews, 1988; Simon;
Vamos); (g) to normalize and promote feelings of universality (Hill &
Knox, 2001; Mathews); (h) to equalize power (Brown & Walker, 1990;
Doster & Brooks, 1974; Enns, 1997; Hill et al., 1988; Mahalik et al.);
(i) to repair an impasse or alliance rupture (Hanson; Simon; Weiner,
2002); (j) to correct misconceptions (Greenson, 1978; Jourard, 1971),
such as tendencies to perceive therapists as omnipotent and omniscient
(Greenson; Rosenthal, 1990); (k) to assist clients in identifying and
labeling their emotions (Bridges); (l) to show similarities (Atkinson
J.R. Henretty, H.M. Levitt / Clinical Psychology Review 30 (2010) 63–77
et al., 1981; Audet & Everall, 2003; Berg-Cross; Hill & Knox, 2001); (m)
to reassure (Hill et al., 1989); (n) to build client self-esteem (Andersen &
Anderson); (o) to demystify therapy (Greene & Geller, 1981; Hill et al.,
1989; Knox & Hill, 2003); (p) to reinforce and/or shape for desirable
client behavior (Andersen & Anderson); (q) to offer alternative ways to
think or act (Hill & Knox, 2001); (r) to help clients recognize boundaries
between what they think and feel and what others think and feel
(Mathews); and (s) to provide clients with authentic, human-to-human
communication (Counselman, 1997; Geller, 2003; Hanson; Hill et al.,
1988; Knox & Hill; Mathews; Rachman, 1998; Weiner). Although the
empirical, analogue data did not support the disclosure rationale of
increasing client trust, the theoretical and anecdotal literature suggested
that it is an appropriate motive (Andersen & Anderson; Berg-Cross;
Miller), especially with clients from nontraditional lifestyles and/or
sociocultural backgrounds that differ from that of their therapist (Curtis;
Goldstein, 1994; Jenkins, 1990; Sue & Sue, 1999).
In addition to these reasons, for therapists disclosing their GLBT
orientation to clients with GLBT orientations, appropriate rationales
may include (a) to create a safe environment where clients know
they will not be judged negatively (Hanson, 2005); (b) to counter
internalized hatred and shame (Satterly, 2006); (c) to be viewed as a
more credible source of help than therapists without a GLBT identity
(Cass, 1979; Atkinson et al., 1981); and (d) increasing positive
qualities related to outcome, such as empathy, understanding, positive
regard, genuineness, spontaneity, confidence, intensity, openness, and
commitment (Liljestrand, Gerling, & Saliba, 1978; Rochlin, 1982).
For therapists who are experiencing illness and/or grief in their
personal life that may affect therapy, additional appropriate rationales
may include (a) reducing fears of abandonment by providing reasons for
therapists' absence (Rosner, 1986); (b) allaying clients' anger over the
interruption (Rosner); (c) eliciting important emotions of compassion,
sympathy, and concern (Guy & Souder, 1986; Mendelsohn, 1996;
Rosner); and (d) providing clients an opportunity to work with issues
around past losses (Philip, 1993).
Therapists need to ensure that they are not self-disclosing for any
of the following reasons: (a) to control or manipulate clients (Rachman,
1998); (b) to attack or assault clients (Rachman); (c) to gratify clients
when not therapeutically appropriate (Tillman, 1998); (d) to emphasize
dissimilarities between therapist and client unless therapeutically
indicated (Berg-Cross, 1984); and (e) to satisfy therapists' needs
(Anderson & Mandell; 1989; Hill & Knox, 2001, Knox & Hill, 2003;
Mahalik et al., 2000; Welt & Herron, 1990), such as working on personal
problems (Rachman), seeking validation and approval (Wells, 1994), or
expressing emotions–like anger–when not therapeutically indicated
(Bishop & Lane, 2001; Hanson, 2005; Geller, 2003). Furthermore, results
from Collins and Miller's (1994) meta-analysis on liking and disclosure
showed that liking others lead us to disclose more to them, so it is
important that therapists not fall prey to this tendency but ensure that
the disclosure is therapeutically indicated.
2.3.2.5. How. When it comes to clients requesting self-disclosure, there
is an unwritten rule that therapists must explore the reasons and
meaning of possible answers with clients before answering the
question. Geller (2003) points out that “insisting on this sequence is
not technically correct. It is rigid. There are clearly patients with
whom one should first answer a question, and then if possible, try to
understand its associated meanings” (p. 548). Just as therapists
should not rigidly enforce this principle, the following guidelines on
how to self-disclose also are not meant to be adhered to rigidly.
The first guideline is that therapists should self-disclose infrequently (Gabbard & Nadelson, 1995; Hill & Knox, 2001, Knox & Hill,
2003; Mann & Murphy, 1975; Simonson, 1976). Wzontek, Geller, and
Farber (1995) found that therapist self-disclosures were one of the few
remarks clients could remember after termination. Knox and Hill
(2003) conjectured that the power of therapist self-disclosure is due at
least in part to the fact that it is one of the rarest therapeutic techniques
73
utilized. Frequent therapist self-disclosures may dilute this potency, so
it is important to choose disclosures wisely.
Thus, the second guideline is to use therapist self-disclosure with
deliberation. Begin the deliberation by identifying what the client is
communicating (Mulcahy, 1998), especially with requests for disclosure. Tillman (1998) points out that some client questions are really
statements, whereas some are means for testing the therapist, and
others are requests with aim for gratification, such as reassurance. For
these three types of questions, it may be more important to explore
the meaning than to provide an answer (Tillman). When therapists
are considering sharing an unsolicited personal association, it is
important to consider its relevancy to what the client is saying and its
fit with the flow of conversation (Mulcahy). Identify whether the
association, or client question, pertains to information that may be
necessary to protect the client's informed consent (Peterson, 2002).
For those disclosures that do not fall under the client's right to know
(i.e., information related to the “nature and anticipated course of
therapy” [APA, 2002]), therapists should ensure that disclosures
correspond with therapeutic goals for the client or with therapeutic
ambitions the therapist has for all clients (e.g., the capability to be
vulnerable; Morrison, 1997). It is important that therapists assess
their own feelings and level of comfort with the disclosure (Mulcahy;
Peterson). Therapists may want to ask themselves, ‘Is my purpose in
disclosing this information to benefit the client or to benefit myself?’
(Peterson). ‘What are my intentions?’ (Mulcahy; Peterson). ‘Are my
reasons for self-disclosing appropriate?’ (Knox & Hill; 2003; see Why
subsection). ‘Might disclosing this information interfere with the
therapeutic progress?’ (Peterson). And, ‘Is there another way I can
communicate this information?’ (Peterson). Because therapist selfdisclosure has risks, it is important to consider utilizing alternative
means for conveying the information.
Therapists also should take into account the client's possible
reactions and realize that the self-disclosure may not have the
intended impact (Peterson, 2002). For example, whereas clients who
want to feel close and connected to their therapists may perceive a
therapist disclosure as rewarding, clients who value separateness
and/or traditional therapy roles may perceive the disclosure as
intrusive or burdensome (Collins & Miller, 1994). Although a divorced
therapist may intend to highlight his similarity to a separated client by
self-disclosing his marital status, among any number of responses, the
client may assume that the therapist is well equipped to understand
her situation; that the therapist is struggling with his own issues, thus
is ill equipped to help her; or, as in the case of a client interviewed by
Hanson (2005), that the therapist wants to date her. Brenner (1979)
points out that even seemingly benign and reflexive self-disclosures
may be inhibitive: “As an example, for the [therapist] to express
sympathy for a patient who has just lost a close relative may make it
more difficult than it would otherwise be for the patient to express
pleasure, or spite, or exhibitionistic satisfaction over the loss” (p. 153).
As is apparent, therapists will have a lot to consider in a short amount
of time. However, once therapists have deliberated and decided to
self-disclose there are several other guidelines to consider.
The third guideline encourages therapists to choose their wording
carefully when self-disclosing (Mulcahy, 1998). How emphatic and
emotionally laden the disclosure is should relate to the client's need (i.e.,
a need for information vs. a need for connectedness; Knox & Hill, 2003;
Rachman, 1998). Knox and Hill, citing Watkins' (1990) research, note
that intimacy level of the disclosure is important as well:
Therapists who disclosed in a non-intimate way received more
favorable reviews and stimulated more client disclosure than those
who disclosed intimate and personal material…. Contrastingly,
although therapists should be mindful not to be too intimate in
their disclosures, they also may need to ensure that their selfdisclosures do indeed contain some degree of intimacy. Part of the
beneficial impact of therapist self-disclosures may arise from
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J.R. Henretty, H.M. Levitt / Clinical Psychology Review 30 (2010) 63–77
clients' sense of therapists becoming more real and more human, of
therapists trusting clients with information about therapists, and of
being given a verbal gift of some part of therapists' lives. (Knox &
Hill, p. 534)
In addition, therapist self-disclosures should contain only the
information necessary to further therapeutic process (Rachman);
details need not be shared (Balint, 1968).
The fourth guideline refers to therapists being responsive to their
clients before, during, and after a self-disclosure (Rachman, 1998).
Although this step includes the deliberation mentioned previously, it
also includes therapists checking in with clients to see how they feel
about their therapist sharing, possibly asking clients' permission. It may
be important for therapists to make explicit their reasons for disclosing.
In addition, therapists “should observe carefully how clients respond to
their disclosures, ask about client reactions, and use the information to
conceptualize the clients and decide how to intervene next” (Hill & Knox,
2001, p. 416). Such a feedback loop may allow therapists to further shape
the impact of the disclosure (Mulcahy, 1998). Furthermore, if therapists
and clients can dialogue openly about a disclosure, even negative effects
may ultimately be very valuable in deepening the understanding of
clients' experience, thoughts, and feelings (Bridges, 2001). However,
because the impact of the disclosure may not be apparent to the client
immediately (Guthrie, 2006), and because the meaning of the disclosure
for the client may shift over time (Bridges), therapists should consider
reexamining, with the client, the impact of the disclosure later in the
course of therapy (Knox & Hill, 2003)—particularly if the therapist senses
that the disclosure has changed the therapy. In Audet and Everall's
(2003) research, participants indicated that unsuccessful use of therapist
self-disclosure arose from a lack of responsiveness. The researchers
concluded the value of disclosure is largely dependent on the
responsiveness of the therapist (Audet & Everall).
The fifth and final consideration on how therapists should selfdisclose is that it is likely to be beneficial for therapists to return the
focus to the client immediately after a disclosure. “In this way,
[therapists] follow their revelation with the implicit message that the
proper focus of the therapeutic work is on the client, not the therapist”
(Knox & Hill, 2003, p. 536). Although this shifting of focus often is
done through requesting client feedback on the impact of the
disclosure, some clients may try to return the attention to their
therapist. The therapist must remain vigilant in keeping the focus on
the client. Flexible adherence to these guidelines may increase the
effectiveness of therapist self-disclosure.
Therapists should consider using self-disclosure because evidence
supports the position that it is a helpful intervention (Hanson, 2005;
Knox & Hill, 2003). However there are no risk-free therapist selfdisclosures (Geller, 2003), and there is no way to be certain of the
benefit or harm of a particular self-disclosure, to a particular client, in
a particular situation (Peterson, 2002). Nevertheless, if therapists
consider these guidelines developed around the who, what, when,
why, and how of their self-disclosure, they may increase their chance
of using self-disclosure in an ethical and effective manner.
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