The relationship that is formed between client and therapist is one of the most critical aspects of the therapeutic process. Research suggests that the therapeutic alliance is the best predictor of an improved treatment outcome, regardless of the treatment modality that was utilized (Ardito & Rabellino, 2011). I believe that we can apply the therapist’s use of self to improve the therapeutic alliance and to model balanced living, true health, and wellness for our clients.
Therapist self-disclosure is an ethical issue that has been long debated within the clinical community. The generally accepted guideline is that “intentional self-disclosure should be client-focused and clinically driven and not intended to gratify the therapist’s needs” (Zur, 2011). According to Ofer Zur, Ph.D., “the decision to self-disclose is based first and foremost on the welfare of the client. Intentional and deliberate self-disclosure is made under the general moral and ethical principles of Beneficence and Nonmaleficence-therapists intervene in ways that are intended to benefit their clients and avoid harm to them” (Zur, 2011).
An example of an appropriate use of self-disclosure and modeling when treating a client with an eating disorder might be if the client states the following, “It just gives me so much anxiety to go out to eat. I feel like I’m going to get fat if I eat a restaurant. How often do you usually eat out?” In this instance, the therapist would have an opportunity to model a more balanced relationship with food by sharing with the client that they eat out a few times a week. This could be clinically helpful to the client, as it serves to normalize the behavior of eating at a restaurant. Of course the use of self-disclosure depends on the specific client, as well as whether the therapist feels that the disclosure would be clinically useful. When used appropriately and in accordance with ethical guidelines, self-disclosure can be a powerful tool to help to strengthen the therapeutic relationship.
The therapist’s use of self within the therapeutic relationship goes beyond verbal self-disclosure. I work as a therapist with adolescent girls and over time it became evident that they pick up on everything. For instance, clients may attune to subtle cues that you send, such as how you dress, your office decorations, and the specific themes or topics that you focus on in sessions. It is important to ensure that the nonverbal messages that you are sending to clients, are in-line with the messages and values that you espouse. For instance, let’s say that you talk to your clients about the importance of having work-life balance, but they notice that you never take a vacation or that you answer their emails late at night. Or if for instance, you are working with a client to address their body image issues and you consistently wear very large and baggy clothing to sessions. This could unintentionally, send the message that you are uncomfortable in your own skin.
An example of appropriate modeling might be if let’s say the therapist made a benign statement that the client perceived as offensive. The therapist could state, “I’m really sorry that you were offended by what I said. I didn’t intend to hurt your feelings. Even us therapists are imperfect and make mistakes sometimes.” Here, the therapist is able to model that making mistakes is a normal part of the human experience. If your client struggles with perfectionism, it could be incredibly clinically useful to model that making mistakes is normal and unavoidable.
This week, I urge you to work to cultivate a mindful awareness of both the verbal and nonverbal cues that you are sending in sessions. This can be helpful not only in promoting your own self-discovery as a therapist, but also in working more effectively with the clients that you serve.
Ardito, R., Rabellino, D. (2011, October 18). Frontiers in Psychology. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198542/
Zur, O. (2011). Self-Disclosure & Transparency in Psychotherapy and Counseling: To Disclose or Not to Disclose, This is the Question. Retrieved from http://www.zurinstitute.com/selfdisclosure1.html