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What My Therapist Could Have Said

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In seventh grade, I realized that I had a crush on my best friend. With horror, I decided I must be a lesbian—13 years old and living in a sheltered suburb outside Philadelphia, I thought this was the end of my life. I had never seen or known of any real-life lesbians. The future I assumed that I would have went *poof*, and I could no longer imagine living through it. Who was I to pave the way as the first lesbian ever? A year or so later, I had the stunning realization that I had a new crush on a boy in my class. Thank god, I thought, I must be straight. Life as I know it can go on.

Clearly, I had no knowledge of the Kinsey Scale or of bisexuality. Ten years later, I put two and two together and finally changed my Tinder preferences to men and women. Although that first step took as little as a tap from my thumb, my full and active coming out process was challenging, confusing and took more than a year. I worked closely with a trusted therapist to put together the pieces. Three years later—out and proud—I heard through a mutual friend that my therapist has been in a long-term marriage with another woman—I didn’t even know she was married, let alone queer.

Applying “use of self” at work can mean a lot of different things. In therapy and social work specifically, it can make or break a client’s progress, depending on the situation. In such a human-centered profession, a clinician’s use of self should be exercised with extreme discretion and thoughtfulness.

Throughout my time with that therapist, I had assumed I was speaking with a straight woman who had not experienced and therefore would never truly understand what I was going through. I felt limited in my willingness to share, explore and develop. Although therapy still played an important role in my coming out process, I found our perceived distance intimidating and restrictive in hindsight. While I respect and would never want to violate somebody’s boundaries, I know that that transparency would have changed my therapy experience to feel more authentic, fulfilling and safe. Instead, uncovering this information on my own was shocking, leading me to feel disconnected and questioning the time that we spent together.

“Use of Self” foundations

Within a clinical context, use of self is defined as a tool available to therapists and other therapists involving “self-disclosure, personality, intersubjectivity, relationality, attachment, belief systems, and embodiment.” There has been ongoing research and debate about the efficacy of this form of self-disclosure. Based on a 2003 study, there are two official types of disclosure of self in therapeutic (client and clinician) relationships, known as “here and now” and “there and then.” Here and now disclosure consists of what the clinician is naturally thinking at the moment. There and then disclosure involves the clinician sharing aspects of their own lives, experiences and lessons learned when relevant and helpful. My therapist could have used a there and then approach to ease my fears and encourage my vulnerability by disclosing to me that she too had gone through the coming out process and is married to another woman.

Although, maybe selfishly, I wish that my therapist would have disclosed her queerness, there are legitimate concerns about the ethics of clinician disclosure. Researchers opposing this use of self argue that bringing the clinician’s personality, vulnerability, worldview and belief systems into the therapeutic relationship has the potential to inauthentically sway the client toward the clinician’s worldview, otherwise known as countertransference. A clinician utilizing the use of self must also deeply understand boundaries and how to engage in productive sharing, while avoiding over-sharing that could lead to countertransference. Proponents argue that a clinician’s self-disclosure can be monumental in a client’s understanding, trust and growth when done tactfully and deliberately. Different clients may range in wanting or not wanting such information from a therapist. The practice is nuanced and will change according to the situation.

The future of clinician self-disclosure

Use of self, or self-disclosure, is a personal choice for everyone, everywhere. In social situations, self-disclosure may be used to connect, seek advice or support, make people laugh, or sometimes (as we all know) for a person just to hear their own voice. Whatever the motive, the trust that self-disclosure can beget is one that we as humans crave. In the therapeutic relationship though, the motive of self-disclosure must be solely for the benefit of the client. In reality, not all clinicians are apt to disclose at only the perfect moments, but I believe it’s something to aspire to. As research on the topic expands and conversations continue, it’s worth exploring the pros, cons and possibilities that a clinician’s use of self can bring to help meet clients’ therapeutic goals.

Getty image by lorenzoantonucci

Originally published: February 14, 2022
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