Category: Alienation

Your therapist can’t stop bragging about themselves.  

Your therapist crosses the line between professionalism to friendship or more. 

Your therapist brings their own baggage into your sessions. 

Your therapist has a “black or white” / “all or nothing” mentality.  

Your therapist is trying to sell you something non therapy related

Your therapist judge your partner/spouse

Your therapist appears to be more interested in making more money

Your therapist keeps contradicting themselves

https://positivepsychology.com/things-therapists-should-not-do/

Boundaries may be at risk if a therapist gradually changes from their usual practice, or drifts away from the goals or contract originally agreed with you.

Other danger signs are:

• rather than focusing on you, the therapist directs energy towards meeting his or her own needs
  – for example, talking about themselves, or unexpectedly ending sessions early
• reversal of roles: you are told about the therapist’s problems and ‘required’ to ‘care’ for them
• the therapist suggests that he or she is the only practitioner or person who can meet your needs
• you are offered additional sessions (which you had not agreed at the outset) without there being a clinical justification
•  the therapist is insincere and/or flatters you n the therapist seems blaming or judgmental towards you
• 
  the therapist flirts with you
  the therapist ‘takes sides’ with you no matter what the situation, or argues with you

We recruited 271 (N=271) practicing therapists from 38 states and 12 countries to participate in research that investigated the extent to which therapists are occasionally dishonest in psychotherapy. Among this sample, 19.2% were male, 79.7% female, and 1.1% other; 61.7% had been practicing less than 10 years, 21.4% between 10 and 20 years, and 16.9% more than 20 years. When asked about primary therapeutic modality, 11.3% of respondents indicated Dynamic, 21.4% indicated Cognitive Behavioral Therapy/Dialectical Behavior Therapy (CBT/DBT), 1.5% indicated Humanistic, 57.9% indicated Integrative/Eclectic, and 7.9% indicated Other. 

The Psychotherapists’ Assessment of Truth, Candor, and Honesty (PATCH) Survey explores the frequency of “therapist lying” across 23 topics:

1.    Being less than alert
2.    Forgetting something a client said
3.    Competence or expertise
4.    Confidence in being able to help
5.    Clinical progress
6.    Clinical availability
7.    Reasons for canceling/rescheduling
8.    Reasons for being late/absent
9.    Conversations with others
10.   Discussing diagnosis
11.   Explaining fees
12.   Discussing training or credentials
13.   Having outside knowledge
14.   Own physical/mental health
15.   Own physical or emotional state
16.   Aspects of one’s own personal life
17.   Personal beliefs or values
18.   Knowledge of someone or something
19.   Liking/disliking clients
20.   Feelings of frustration/disappointment
21.   Romantic/sexual feelings for a client
22.   Reasons for not taking on a client
23.   Reason for termination

The frequency of lying for each topic is measured on a 7-point Likert scale with 1 = Never, 4 = Sometimes, and 7 = Frequently. Therapists’ responses to the scaled lying items were averaged to determine the most common topics of lies.    

In addition to our lab’s overarching hypothesis that therapists occasionally are less than completely honest more frequently about certain topics, we also hypothesized that more experienced therapists dissemble with greater frequency.  Since therapists theoretically become more comfortable navigating conversations in psychotherapy as they gain more experience, we predicted that a longer period of time practicing therapy would correlate to an increased ability to use tools of redirection and tactful concealment. To study this hypothesis, we performed a Latent Class Analysis (LCA) to identify class membership by lying topics. The distinct classes were then compared to the demographic variables “practice years,” “studentvs. non-student,” and “age” to determine if experience effects the lying behavior of therapists.

The present paper has provided some considerations for psychotherapists assessing the potential harm or good that may come out of a given piece of self-disclosure. Gleaned from the above discussion, the following questions are intended to guide decision-making about using effective and beneficial self-disclosure in psychotherapeutic practice:

• a) Is this piece of self-disclosure intended primarily to help the client or to a gratify a personal need (of, for example, validation or support from the client)? If it is the latter case, the therapist may benefit from addressing the issue at hand in supervision, consultation, or personal therapy.
• b) Does the client need to know this piece of information to make informed consent about his or her treatment?
• c) Might this disclosure negatively impact the client’s perception of the therapist’s competence and professionalism?
• d) How much and how often is the therapist disclosing with a particular client?  Might the amount of disclosure be excessive and thus distract from focus on the client?
• e) What type of self-disclosure is being used? Immediate or non-immediate? What does the research say about this kind of disclosure?
• f) How does the therapist conceptualize self-disclosure from his or her chosen theoretical orientation? That is, what kind of self-disclosure, if any, is consistent with what he or she believes is the agent of change in psychotherapy?
• g) Is the decision to disclose informed by the client’s cultural context?
• h) Is the decision to disclose informed by the client’s developmental age or stage?
• i) Does the client display personality traits that make it more likely that he or she would be harmed by the therapist’s disclosure?
• j) Might the therapist’s desire for keeping certain personal information private negatively impact the client? If so, how can the therapist utilize supervision to minimize harm to both the client and her or himself?

By regularly contemplating these questions, a psychotherapist may come to develop his or her capacity to use self-disclosure in an optimally beneficial and ethical manner.+310

Sadighim, S. (2014). The big reveal: Ethical implications of therapist self-disclosure. Psychotherapy Bulletin, 49(4), 22-27.

Sherry Sadighim, M.A.

Anna Ruddle and Sarah Dilks consider whether therapists should talk about themselves in therapy.

As with any therapy skill, guidelines on TSD would need to be used flexibly. Use of TSD is likely to vary according to the therapeutic approach, stage of therapy, therapist’s professional experience, personal preference, therapy process issues and the interaction between all these factors. While some guidance about staff self-disclosure exists in the recovery literature (e.g. Scottish Recovery Network, 2007) and some NHS Trusts are developing guidance (e.g. Dorset Wellbeing and Recovery Partnership, 2013), we are not aware of any specific to therapy. Henretty and Levitt (2010) do provide some detail in their helpful recommendations about ‘what’, ‘when’, why’ and ‘how’ to self-disclose in therapy, based on their literature review. For example, they recommend that therapists ‘self-disclose infrequently’ and ‘take into account the client’s possible reactions’ (p.73). However, their recommendations make clear there are no hard-and-fast rules for TSD. Rather, TSD requires careful consideration in relation to each specific client and their individual context. We would therefore encourage therapists to bear these what, when, why and how questions in mind whenever considering the use of TSD.

In addition it is also worth thinking about when not to self-disclose as a therapist (e.g. when a negative consequence is possible or likely). 
For instance, when the TSD may:

I    invoke envy in a client (e.g. ‘I’m off to the Bahamas’); 
I    involve a personal experience the therapist has not overcome sufficiently to remain objective;
I    open up areas of questioning the therapist is not comfortable with;
I    inappropriately shift the focus of therapy to the therapist (as one client put it, ‘It almost felt like a parent–child relationship… like I was the therapist and she was the patient getting everything off her chest’: Audet & Everall, 2010, p.335); or
I    encourage confusion about the nature of the relationship (e.g. TSD for some may imply that a more intimate personal relationship is possible).

With regard to ‘how’ to disclose, the therapist could consider informing a client that they might occasionally do this, or could seek permission in advance of a disclosure they think may have particular impact. They may also want to ask the client what their experience was of the TSD and possibly return to it later in therapy. Finally, therapists might consider rehearsing a warm but clear way of saying they are not comfortable continuing with a particular topic.

https://thepsychologist.bps.org.uk/volume-28/june-2015/opening-disclosure

 I found the article, ‘Opening up to disclosure’ by Anna Ruddle and Sarah Dilks (June 2015) a refreshing reminder of the complex issue of how much, if at all, a therapist might choose to reveal about themselves to a client.

Of course, therapists self-disclose the minute a client walks into the consulting room. The therapist’s wedding ring, for example, might have particular significance for a client struggling with divorce or sexual identity. But, it is the purposeful act of self-disclosure that is at the heart of the matter.

Whilst self-discourse can undoubtedly serve as a positive therapeutic factor, it also offers the therapist an unhelpful avenue to self-indulgence cloaked in a belief that it is really for the good of clients. As Storr (1990) noted, therapists, just like clients want acceptance and understanding but a psychotherapy session is not the place to fulfill such needs.

Dr Alistair McBeath
Edinburgh

1.    WAIT! 

Consider first – Why Am I Telling?

2.    Be brief

Research suggests that long and drawn out narratives are considered by clients to be both unhelpful and damaging to the therapeutic relationship. Keep it brief and to the point!

3.    “I” Statements

Make it clear that you are giving YOUR opinion based on YOUR experiences only. It can be easy for clients to assume that you are referring to your clinical experience and expertise, this is misguiding.

4.    Consider your client’s values

5.     Consider the impact

https://www.opencolleges.edu.au/careers/blog/self-disclosure-in-counselling