Psychotherapy Volume 38/Spring 2001/Number 1

THERAPIST'S SELF-DISCLOSURE: EXPANDING THE

COMFORT ZONE
NANCY A. BRIDGES
Department of Psychiatry, Cambridge Health Alliance
Harvard Medical School, Smith College School for Social Work
While most therapists engage in some
form of disclosure, intentional The author gratefully acknowledges Francis Givelber,
decisions to share feelings and Chris
personal views with patients remain a
complex area of clinical practice; This McElroy, and Paula Rauch for comments on an
earlier draft of this article.
article offers
Correspondence regarding this article should
O o parameters for the use of intentional be addressed to Nancy A. Bridges, LICSW,
self-disclosure in the context of BCD, 135 School Street, Belmont, MA 02478.
an ongoing relational Goldstein, 1994, 1997; Gorkin, 1987;
psychotherapy. When Greenberg, 1995; Hanly, 1998; Jacobs, 1991;
psychologically attuned and Lehrer, 1994; Levenson, 1996; Marcus, 1998;
patient centered, intentional Maroda, 1999b; Milatec, 1998; Modeli, 1991;
Pizer, 1997; Raines, 1996; Renik, 1991,
disclosure opens up space for
1995; Simon, 1988; Strean, 1997; Tansey &
deep therapeutic engagement Burke, 1989, 1991; Waska, 1999; Wells,
between therapist and patient. It 1994; Wilkinson & Gabbard, 1993). A
0 heightens self-perception, affective theoretical shift from an intrapsychic to a
experience, and relational relational model for psychotherapy facilitates
connection. Clinical vignettes self-disclosure in psychotherapeutic work
are used to illustrate the (Aron, 1991; Burke, 1992; Fosshage, 2000;
intentional use of self-disclosure Hoffman, 1983; Maroda, 1999b;
that opens up the possibility of McLaughlin, 1995; Mitchell, 1988; Renik,
deeply personal and 1991, 1995; Stolorow, Atwood, &
transforming conversations Brandchaft, 1994). In a relational model,
benveen therapists and patients transference is viewed as an interpersonal
field in which there is mutual, bidirectional,
that advances psychotherapeutic interactive influence between therapists and
aims. patients (Ehrenberg, 1995; Fosshage, 2000;
Maroda, 1999a•, McLaughlin, 1995). A
In recent years, there has been increased developmental, relational therapeutic
interest and use of self-disclosure in perspective that focuses on the patient's
psychotherapy (Anderson & Mandall, 1989; mastery of affective states and self-
Aron, 1991, 1992; Broucek & Ricci, 1998; development invites the therapist's direct use
Burke, 1992; Busch, 1998; Cooper, 1998a, of his or her own affective and relational
1998b; Cornett, 1991; Darwin, 1999; experience (Cooper, 1998b; Cornett, 1991;
Ehrenberg, 1995; Epstein, 1995; Darwin, 1999; Ehrenberg, 1995; Hoffman,
1983; Maroda, 1991, 1999b; Mitchell, 1988;
Renik, 1991, 1995; Stolorow et al., 1994). In

21
Nancy A. Bridges
such a model, the therapist is a fully participating
subject in the relational matrix who relies upon the
expertise of the patient and tolerates the anxiety
associated with an uncharted treatment approach
(Aron, 1991; Hoffman, 1983; Mitchell, 1988; Renik,
1995; Stolorow et al., 1994). The negotiation of
connection and disconnection in the therapeutic
relationship becomes central to the therapeutic
process. A willingness to be open to influence from
within and between psychotherapy participants
opens up a wide range of previously unthinkable
therapeutic interventions.
Intersubjective therapists argue that we disclose
whether we intend to or not and emphasize the
centrality of the therapist's subjectivity in the
therapeutic relationship. This stance encourages an
openness to many types of disclosure, depending on
the clinical relationship and context (Aron, 1991;
Cooper, 1998a, 1998b; Ehrenberg, 1995; Hoffman,
1983, 1994; McLaughlin, 1995; Stolorow et al.,
1994). From this perspective, self-disclosure is not
only an inevitable, but also an essential aspect of the
psychotherapeutic process.
Drawing from relational
intersubjective perspectives, this article
examines intentional self-disclosure by
therapists including sharing of affects,
motives, intent, and personal opinions in the
context of an ongoing relational
psychotherapy. Therapist's disclosure of
personal information to patients is not
addressed. Clinical vignettes illustrate how
the intentional use of selfdisclosure opens up
the possibility of deeply perO o sonal and
transforming conversations between therapists
and patients that advance developmental and
relational aims. Intentional selfdisclosure is a
valuable tool in a therapeutic relationship that
facilitates exploration, introduces new
perspectives on the self in relationship, and
conveys to the patient the possibility of
creating a new, healing object relationship
(Aron, 1991; Broucek & Ricci, 1998; Cooper,
1998a, 1998b; Ehrenberg, 1995; Levenson,
1996; Maroda, 1999b; Pizer, 1997; Raines,
1996; Renik, 1991, 1995; Waska, 1999).
Therapist self-disclosure may be a helpful
vehicle to make conscious unconscious affect
or relational dynamics that influence the
treatment and benefit to the patient's
development (Cooper, 1998a, 1998b; Darwin,
1999; Ehrenberg, 1995; Maroda, 1991,
22
1999a•, Renik, 1991). When carefully
considered and psychologically attuned,
therapists' disclosures to patients may lead to
unexpected clinical opportunities that deepen
the therapeutic relationships and add a novel,
growth-fostering dimension to the work.
Instances in which self-disclosure may be
unhelpful or have an untoward effect are
discussed as well.
It is hoped that this article will
contribute to the ongoing dialogue
about the value of therapists' self-
disclosure in psychotherapeutic
relationships. With more clinical
exposure and ways to conceptualize
such practice, therapists may expand
their comfort zones with intentional
selfdisclosure in therapeutic
relationships viewing self-disclosure
as an inevitable, integral, and essential
therapeutic tool.
Rationale for Disclosure
The literature suggests several conceptual
frames to inform decision-making about
and
intentional self-disclosure (Anderson &
Mandall, 1989; Aron, 1991; Broucek &
Ricci, 1998; Burke, 1992; Cooper, 1998b;
Cornett, 1991 ; Darwin, 1999; Ehrenberg,
1995; Epstein, 1995; Jacobs, 1991; Maroda,
1991 , 1999a, 1999b; Raines, 1996; Renik,
1999; Simon, 1988). Aron (1991) framed
subjectivity in disclosure as a mindful effort
to reveal to the patient an aspect of the
therapist's self with the intent of opening up
space for something new to be explored or
understood. Cooper (1998b) articulated three
therapeutic aims of disclosure, namely an
effort to make something conscious that is
currently unconscious in the transference; to
create a new mode of inquiry and discovery;
and to convey to the patient that the therapist
is, or could be, a new object. Maroda (1991 ,
1999a, 1999b) suggested that the analyst's
emotional responses to the patient are the
mainstay of disclosure and that such
feedback provides the patient with vital
information to understand and master affect.
Affective disclosures that help the patient see
himself or herself as others do are
emphasized (Maroda, 1999b). Other writers
have argued for allowing the therapist to be a
fully participating subject in the treatment
relationship, engaged in candid dialogue

facilitating an effective collaboration between
therapist and patient (Broucek & Ricci, 1998;
Goldstein, 1994; Raines, 1996; Renik, 1999).
Risks
The literature argues for certain safeguards to
ensure that disclosure is monitored and assessed
continually by therapists (Cooper, 1998a, 1998b;
Maroda, 1991 , 1999a, 1999b; Raines, 1996; Renik,
1999; Simon, 1988; Wells, 1994; Wilkinson &
Gabbard, 1993). The fiduciary principle must be
honored and informs therapists' decisions regarding
disclosure. Therapists guard against excessive
disclosures, disclosures that shift the focus away
from the patient, or disclosures that might harm
monitoring the effect of such interventions on the
patient and the treatment process. Continual self-
scrutiny is required for therapists to fully understand
their own interests and influence on the clinical
process (Aron, 1991 ; Bridges, 1999; Cooper,
1998b; Ehrenberg, 1995; Goldstein, 1994; Maroda,
1991, 1999a, 1999b; Raines, 1996; Tansey &
Burke, 1991).
Many patients report a range of feelings about the
therapist's self-disclosure and the impact on the
therapeutic relationship (Anderson & Mandall,
1989; Bridges, 1999; Levenson, 1996; Maroda,
1991, 1999a, 1999b; Simon, 1988; Wells, 1994).
While most therapists admit that intentional as
well as unintentional disclosures are
inevitable, one never knows in advance what
effect such disclosures will have on a patient
or the therapeutic relationship. Patients may
be reluctant to report the full range of feelings
and reactions to a therapist's disclosure
(Anderson & Mandall, 1989; Levenson, 1996;
Wells, 1994). To enhance the therapeutic
value of self-disclosure, the therapist must
initiate, and be prepared to work through, the
full range of a patient's feelings and reactions
(Ehrenberg, 1995; Levenson, 1996; Maroda,
1991, 1999a, 1999b; Simon, 1988; Wells,
1994).
Fortuitous or spontaneous disclosures by
therapists hold the same potential for the full
range of beneficial and untoward effects as do
intentional disclosures by therapists. The
interpersonal and intrapsychic effects of any
fortuitous disclosure on the patient, the
therapeutic relationship, and the therapeutic
process are revealed through careful
therapeutic inquiry focused on elucidating the
multiple meanings of the event to the patient.
Therapist's Self-Disclosure
Ultimately, the range of positive and
negative effects of unintentional disclosures
is discovered mutually in the therapeutic
dyad.
Therapeutic Guidelines Concerning
Disclosure
Most clinicians appreciate the clinical
intuition, timing, and sensitivity that inform
the decision to disclose in any treatment
dyad. As illustrated in the following
vignettes, therapists employing intentional
self-disclosure are advised to remain patient
focused, rely upon the patient's resources and
expertise, model emotional honesty, and
share their view of the clinical situation at
hand. Exploration of the multiple
interpersonal and intrapsychic meanings of
the disclosure to the patient and the treatment
process is essential.
Introducing New Perspectives on
Self in Relationship
Often, patients live with positive
and negative self-distortions and
transference schemas that do not serve
them well. They do not see
themselves accurately. An outside,
discrepant opinion about self in
relationship is invaluable to many
patients. Patients may lack self-
observation skills and feel injured or
entitled to their view even when it
does not work well in relationships.
Consider the following vignette:
Case Illustration
A profoundly lonely and isolated woman presents for
psychotherapy requesting help with relationships. While
she does not understand the course of relational events,
she knows that she has a pattern of alienating and
offending others. Unaware of how she contributes to
these dilemmas, she also is exquisitely interpersonally
sensitive. She presents a current dilemma with her
husband around a painful interaction and is seeking her
therapist's assistance. The patient has scripted a response
to her husband that the therapist feels is sadistic,
selfcentered, and likely to prompt a sadistic response in
retum.
The therapist wonies about offering his view and
responds to his patient by commenting, "I see how hurt
and angry you feel with your husband. You long for
more of his understanding and attention. Would you like
an outside opinion about what might be useful here?"
The patient agrees. The therapist continues, "I worry'
that you do not fully understand how your words affect
23
Nancy A. Bridges
others. I know you are hurt and angry and may wish to hurt in
return but I feel your greater wish is to have more of your
husband's compassionate attention. I'm afraid if you present your
side in this fashion that you will most likely receive an angry,
hurtful response in retum. While it is, of course, your choice, I
don't think that would be helpful to you. When you are hurt and
angry, it is very difficult for you to imagine how the other person
feels and to have a conversation that owns your disappointment
and his feelings as well. Maybe we could help you figure out a
way to present your side that would increase your chances of
being understood."
Our patients need and want our assistance with
those feelings and dilemmas that they cannot see,
understand, or shift on their own. Despite the
inherent injury involved in having self-deficits or
relational dilemmas highlighted, when an outside
perspective is offered in an insü•uctive and
compassionate manner, patients may be very
appreciative. Patients need our emotional and
observational feedback to see themselves the way
that others do (Ehrenberg, 1995; Maroda, 1991 ,
1999a, 1999b; Renik, 1991; Wilkinson & Gabbard,
1993). Often, such feedback involves therapist's
self-disclosure around affect, relational experiences,
and our view of the dilemma at hand.
Disclosure of Countertransference
The use of countertransference disclosure around
therapeutic impasses has been well documented in
the literature (Darwin, 1999; Ehrenberg, 1992;
Gorkin, 1987; Maroda, 1991, 1999a, 1999b;
Taney & Burke, 1989, 1991). In difficult
phases of psychotherapy, when affect
becomes unbearable for the therapist or the
patient, spontaneous self-disclosures may
occur. Born out of frustration rather than
formulation, these moments often provide
therapeutic opportunities that otherwise would
be lost. For example, a therapist struggles to
contain her anger and injury with a patient
who relentlessly criticizes and responds to her
with contempt. She has tried unsuccessfully to
discuss this relational pattern with her patient,
who refuses all efforts to examine his
behavior or feelings. At a particularly difficult
phase of the treatment when the therapist feels
under siege, she blurts out, "I'm not sure how
much longer I can work under these
conditions." Her spontaneous disclosure of
frustration matches her patient's aggression,
captures her patient's attention, and facilitates
a new conversation concerning their
relationship, his relational patterns, and
worries about connection.
24
These unsupervised moments predictably
occur in therapeutic relationships. The
therapist's task is to view the disclosure as
carrying important therapeutic information
about the patient's and therapist's inner
experiences, the relational experience, and
the state of the psychotherapy. After the
disclosure, therapist and patient construct
mutually the multiple meanings and how to
advance the therapeutic work.
Countertransference Disclosure of Disowned
Affect and Relational Connection
For patients who have trouble identifying
their inner experience, a common state of
countertransference involves the therapist
acting as a container or receptacle for the
patient's transference (Hirsch, 1998;
Wilkinson & Gabbard, 1993). In these
situations the therapist offers
countertransference disclosures as a means of
beginning to identify and explore material
that may be unconscious or otherwise would
be unavailable to the therapeutic process
(Gorkin, 1987; Maroda, 1991, 1999a, 1999b;
Taney & Burke, 1989, 1991; Wilkinson &
Gabbard, 1993). Consider the following
vignette.
Case Illustration
An isolated young man with a chaotic inner
world, who is sensitive to abandonment and
shamed by the intensity of his feelings, denies
that he has any feelings or reactions about his
therapist's impending absence. From the
therapist's perspective, it has been a year of
therapeutic gains as she has experienced the
patient's increasing sense of self and a
deepening of the relational connection. She
worries that this disruption in connection may
be particularly traumatic for her patient given
the gains across the year. Several weeks before
his therapist's leave taking, he reports that
suicidal ideation has returned and he worries
about his safety. After addressing safety
concerns, the therapist turns her attention to
understanding the suicidal ideation and wonders
if these symptoms are related to her upcoming
vacation. The patient remains unable to identify
any feelings.
Given her patient's inability to identify or articulate
his feelings, the therapist chooses to disclose her feelings
and observations about the patient to facilitate
exploration and hopefully help identify unconscious
affects that may place him at risk. The therapist
comments, "I have felt very close to you, very connected
to you this year. You have come to count on me and
have let yourself become very involved with our work

and me. It feels to me that you allowed me to care for you, to
help you in new ways. I imagine my vacation will be difficult
and will stir a range of feelings and reactions, including sadness
and anger. I'm sorry my absence will make things harder for you.
I will miss you while I am away and will think of you.
The patient listens silently and then turns his attention to a
painted figurine in the therapist's office wondering if the object is
a recent addition, as he has never noticed it before. The patient
continues by sharing observations about the figurine stating
"What an angry face!" The therapist comments "His therapist is
going on vacation. " The patient looks at the therapist and smiles
with affirmation.
The therapist took a risk here, a preformulated
calculated risk. Her subjective experience of
increased closeness and connection was presumed
to represent the state of affective attunement
between therapist and patient. The therapist held the
disowned, shameful affects around longings,
connection, sadness, and anger that represented her
subjective experience and imitated the patient's
experience. The patient's association to the
figurine's angry face and the patient's smile after the
therapist's comment confirmed the therapist's
hypotheses. The point here is that the therapist
understood her experience as mutual and cocreated
in the therapeutic relationship although not named
by the patient. Her disclosure was an attempt to
assist the patient in identifying and naming his
affective and relational experience. An attitude of
openness and inquiry is essential at these moments
(Wilkinson & Gabbard, 1993). The patient is invited
and expected to agree, disagree, and revise the
therapist's comments and disclosures. The
therapist's disclosures can be viewed as editorial
comments that the patient may play with or discard
but which become part of the permanent relational
record for future examination.
Therapist's Vulnerability
Therapists who are confused about the nature of
therapeutic action and ambivalent about
selfexposure and vulnerability may retreat from
open, honest conversations with patients including
intentional self-disclosure. Sometimes the more
comfortable position for the therapist is to remain
protected behind a professional veneer that
forecloses the experience of intense affect, deep
conversations, and self-disclosure (Bridges, 1999;
Ehrenberg, 1992, 1995; Maroda, 1999a, 1999b;
Renik, 1991; Stolorow et al., 1994). While
therapists continually disclose and self-reveal in
therapeutic relationships, intentional self-disclosure
with patients often involves a heightened discomfort
or a sense of disequilibrium for the therapist
Therapist's Self-Disclosure
(Ehrenberg, 1995; Maroda, 1999a, 1999b;
Renik, 1991, 1995).
A willingness to intentionally
disclose and share your view in
therapeutic relationships, means
allowing your patient to see you, to
know you, and to engage in what may
feel like a personal conversation that
has a therapeutic intent and purpose
(Aron, 1991; Broucek & Ricci, 1998;
Ehrenberg, 1995; Maroda, 1991,
1999a, 1999b; McLaughlin, 1995;
Renik, 1991; Stolorow et al., 1994). As
therapists reveal feelings and aspects of
themselves they, too, feel vulnerable
and exposed to the scrutiny of patients
(Bridges, 1999; Ehrenberg, 1992,
1995; Maroda, 1991, 1999a, 1999b;
Renik, 1991).
Several authors (Ehrenberg, 1992,
1995; Maroda, 1991, 1999a, 1999b;
Renik, 1991) speak directly to these
concerns when they discuss self-
disclosure in relationship to the
therapist's vulnerability. The therapist's
comfort level is at stake, and there is
no way to know how the meaning of a
disclosure will shift across a
therapeutic relationship and changing
affective states. For these reasons,
therapists are often reluctant to share
personal material unless a modicum of
trust and rapport has been established.
Even then, there is no guarantee how
the patient will hold the disclosure, as
illustrated in the following vignette.
Meaning of Disclosure Shifts with
Relational and Emotional State
Case Illustration
A patient in a long-term psychotherapy that has
helped him transform his sense of self and quality of life
is struggling with the logistics of managing a stressful
career, managing a household, and caring for young
children. Having grown up in a desperately poor family
riddled with chaos and violence, and now in an affluent
position, the patient has no historic models for how one
organizes such a life. The therapist over the years has
assumed valuable developmental and emotional roles
with this patient acting as a psychological guide, mentor,
coach, mother, father, and sibling. The patient wants to
know how the therapist manages similar logistics in his
life. After exploration of the meaning of the request, the
therapist shares personal information about how his
25
Nancy A. Bridges
family manages such logistics including hiring household help.
The patient appreciates the disclosure and finds it helpful.
Several years later after a divorce that decreased the patient's
standard of living, he is again stressed by the logistics of
managing all the responsibilities in his life. He is enraged at his
situation and at the people around him experiencing the loss of
the marriage and decrease in standard of living as a descent into
the deprivation of his childhood. In a moment of anguish when
he feels his therapist has misunderstood him and become "other,"
with contempt he snarls, "How could you understand! Look at
your life. I don't have household help like you do. You can't
possibly understand!"
The therapist felt hurt and angry and regretted
that the patient had this personal information. For a
moment, the therapist spiritually left the patient and
internally focused on his feelings of injury. Feeling
stunned that a disclosure that had seemed so helpful
years earlier was now being used in the service of
the patient's rage and despair, the therapist felt
attacked personally. Realizing that disclosures are
filtered through the lens of shifting emotional and
relational states, the therapist had a new sense of
what was potentially at stake with personal
disclosures and the excruciating degree of
vulnerability involved.
Despite the therapist's best effort to engage in an
authentic process of negotiation and exploration
about the meaning of a therapeutic selfdisclosure, it
is often not possible to know in advance how the
disclosure will affect the patient, the therapeutic
relationship, and the treatment process. Time and
further conversation may be needed for the therapist
and patient to discover mutually the multiple
meanings and effect of the disclosure.
As in the vignette above, the meaning of the
disclosure may shift across time. Trial, error, and
time may also bear out that a disclosure was
harmful or unhelpful. The most thoughtful,
wellintentional self-disclosures may have an
untoward effect. If processed in the treatment dyad,
even untoward effects may ultimately be very
valuable in deepening the understanding of a
patient's experience and feelings. On occasion, some
patients may be unable to initiate such a
conversation with the therapist, so the responsibility
for examining and reexamining the meaning and
effect of the disclosure rests with the therapist.
Self-Disclosure in the Service of Repairing
Injuries in the Therapeutic Relationship
When a therapist crosses a boundary or injures a
patient, self-disclosure is often a necessary part of
the process in understanding the internal and
relational meaning to the patient and repairing the
26
connection. As in the case below, an
important piece of repairing the injury with a
patient is the therapist's taking responsibility
for her contribution.
Case Illustration
A young woman comes for treatment of her
depression, mxiety, and profound sense of isolation. An
accomplished professional, her complaint is that she has
no life outside of her career. She is not one to complain,
but if she allowed herself to reflect on her life she would
say she was unhappy. While deeply lonely, it is
hard for her to have her therapist's undivided
attention. Often the patient süuggles to stay
connected to herself and identify how she wishes
to use her session.
After several months of treatment, the patient
arrives for her session and begins to update the
therapist on her thoughts and feelings. The
therapist notices she is half-listening as her
thoughts are pulled to her own concerns, a
lecture she is to deliver after this therapy
appointment. Catching her mind drift from her
patient, she refocuses. As she observes her
patient's face, she notices her patient's expression
has shifted into a mask of sadness. The therapist
wonders and asks her patient "What are you
feeling now?" The patient doesn't have any idea.
The therapist continues "You look very sad. "
The patient bursts into tears, weeping too
vigorously to speak and then, comments "I'm
boring. I think I'm boring you. " The therapist
wonders silently if the patient noticed her
attention drift away.
Rather than impose her hypothesis on the
patient's experience, the therapist asks the
patient, "Is there something I said or did that
made you think I was bored? The patient
responds, "It was your behavior, the way you
looked." The therapist now believes that her
patient did notice her attention shift and feels it is
important to share this information with her. The
therapist discloses that, in fact, her attention had
wandered for a moment. "I was not bored nor do
I find you boring. A matter in my own life
captured my attention for a moment. I wonder if
that was what you noticed. I was internally
occupied and not focused on you." The patient
affirms she had noticed.
The therapist did not find this woman boring;
rather, she experienced this patient as very bright,
thoughtful, and earnest, with a refreshing sense of
humor. The therapist apologizes "I can see my divided
attention has hurt your feelings, and I'm sorry. I was the
cause of the distraction; it was not about you. But I
wonder if this reminds you of other moments in your
life. " The therapist inquires about the patient's
assessment of herself as "boring" and wonders if the
patient has had that feeling before in relationships.
New material is explored about the patient's private
experience of the self and her shame around "having
nothing to say" when she is with people. It becomes
clearer that this patient's deep-seated internal doubts and

negative attributes cloud her assessment of herself in
relationships. She has a distorted view of how others perceive
her. Later in the session, the therapist comments "This
conversation helps me understand why you are so reluctant to
place yourself in social settings. You are very sensitive and
perceptive of others. Perhaps you notice others' reactions but do
not have enough data to know whether someone's reaction is
about you or not. Without data to the contrary, you hold yourself
responsible for others' feelings and reactions. It's easy to
understand that you might want to protect yourself from that
injury and disappointment. "
The therapist's disclosure in this case was in the
service of repairing an error, an empathic failure.
While the therapist knows that simply informing her
patient that she is not boring will not alter the
patient's self-perceptions, she wants to establish a
collaborative stance with her patient in the
therapeutic relationship, inviting feedback and
discrepant opinions. Emotional honesty is important
in all psychotherapy relationships, especially with
patients who are uncertain about who they are or
how they feel. With this disclosure, the therapist's
response provides a model of emotional honesty for
the patient while challenging her prevailing self-
views.
Making Conscious Unconscious Affect and
Relational Patterns
One of the most challenging dilemmas for
therapists is to choose to address directly the
patient's objectionable affects or character traits that
offend
or alienate. While therapists worry about how to
sensitively begin a conversation about a patient's
effect on others, including the therapist, these
moments are often invaluable to our patients and
begin the process of the patient increasing her self-
awareness and building mutuality in relationships.
Therapist's intentional self-disclosure may deepen
the capacity for insight and for relationships
(Raines, 1996). Consider the following vignette.
Case Illustration
A 30-year-old single man with a childhood history of sexual
abuse has been in psychotherapy for 2 years for treatment of his
anxiety and depression. This man feels fundamentally alone in
the world and unworthy of care. Despite his terror of becoming
dependent upon the therapist, he develops a close, yet ambivalent
attachment to his therapist. As buds of hope about himself and
his future begin to develop, the therapist's vacation approaches
and the patient develops severe separation anxiety, a deepening
of his depression, and rage at his therapist for leaving him.
Humiliated by the depth of his feelings and attachment, he
refuses all help around his therapist's absence.
When the therapist returns, the patient is flooded with
murderous rage and recounts the suicidal despair and
Therapist's Self-Disclosure
hopelessness he barely contained during the therapist's
absence. During sessions, he recounts his sadistic night
and day dreams about harming his therapist. Her
patient's rage and sadistic entitlement is difficult for the
therapist to bear.
Clearly, the patient's distress is a reaction to his
therapist's absence and the feelings this loss stirs for
him. Trying out multiple hypotheses of how to formulate
exactly this patient's affective and relational dilemma,
the therapist shares her best guesses with her patient in
an effort to offer containment and convey to her patient
her understanding of the depth of his shame, injury, and
anger. The therapist offers, "My vacation came at a very
bad time, just when you let your guards down and were
counting on me. My leaving you so abruptly, without
any help, must pick the scab off the feelings you had as a
child when your mother violated you." Subsequent
sessions are devoted to exploring his childhood
experiences of helplessness and injury and associated
feelings toward his mother and other offenders.
The patient settles momentarily. However,
his rage does not abate, and his fantasies turn to
sadistic sexual torture of his therapist. After
recounting a particularly brutal dream in which
the therapist is recast as a bug that the patient
dissects and then destroys, he turns to his
therapist and asks, "Aren't you ever afraid
someone will physically hurt you in your
office? You're not very big." Without the
benefit of internal or external supervision, the
therapist responds almost reflexively to feeling
so threatened. "If you physically hurt me our
relationship will be over. I will not work with
you and I will press charges." The therapist
feels as if the patient crossed a boundary, an
emotional boundary, as his comment implied a
threat of crossing a physical boundary. She
knows her patient has the fantasy of
behaviorally reenacting his childhood trauma in
the consulting room with the patient cast in the
role of perpetrator and the therapist as helpless
child.
The patient is startled by the therapist's
comments and O o responds, "I would never physically
hurt you." Therapist and patient explore the intrapsychic
and interpersonal meaning to the patient of the
therapist's disclosure. While the sharply defined limit set
by the therapist initially hurts the patient's 0 feelings, it
offers containment and facilitates the exploration of new
material and affects. me therapist feels it would be
beneficial to share her feelings and thinking with the
patient. "I appreciate your telling me that, and I'm sorry I
hurt your feelings. That was not my intent. I'm not sure
you appreciate 0 fully the strength of your feelings and
how you affect others. Your comment about physical
harm scared me. Frankly, I think it was also an
indication that you were frightened by the intensity of
your anger and fantasies. We need to find a way to
discuss your anger and hurt that doesn't scare you or me.
" The patient shares his knowledge of how he
disconnects from painful affect and then is startled when
he confronts the affect mirrored by another.
Subsequent sessions focus on his malignant
inner view of himself and belief that he would
be violated and ultimately abandoned in any
27
Nancy A. Bridges
relationship. me therapist shares her view. "You have
felt more cared for in our relationship than ever before
in your life. I imagine it's disorienting and scary. cared
for prompted feelings of wanting to flee or destroy the
relationship. It's hard to tust that this relationship could
be different." They agree to monitor the cycles of
connection and disconnection from his internal affective
experience as well as in the therapeutic relationship.
In this vignette, the therapist's self-disclosure
of affect and her understanding of the
clinical dilemma were vital to reestablishing
psychological safety and deepening the
therapeutic conversation. In addition, the
patient needed to hear from her about her
resonance with his inner experience of terror
and of losing control and losing her. The
needed intervention was a statement of how
this patient affects his therapist. The
identification and exploration of the patient's
feelings and issues helped differentiate the
therapist from past relationships and convey
to the patient the possibility of developing a
caring, connected relationship with this
therapist.
The therapist's self-disclosure provided
containment and deepened the interpersonal and
intrapsychic understanding of feelings and the
relationship. While her many formulations were
reasonable best guesses, it was after the disclosure
of affect and intent that the therapist and patient
mutually formulated the intrapsychic and relational
meaning that informed the next phase of the work.
Deepening the Therapeutic Conversation and
Healing Relationship
Case Illustration
At the beginning of treaünent. Ms. A, a woman in her late
fifties, was unable to have any positive feelings about herself or
others or hold any memories of pleasant events. She was filled
with confusion, deep unconscious longings, selfcontempt, and
rage.
After several years of psychotherapy, Ms. A told her therapist
how much better she felt about herself and that she felt close to
the therapist. She would like to give her therapist a gift of
appreciation, a thank-you, for all her help. Ms. A revealed she
wanted to give the therapist a piece of inexpensive, cherished
jewelry she had purchased many years before from a
symbolically significant country. She, however, only wanted the
therapist to have the gift if she liked the item and would wear it.
At first, the therapist was startled by this unusual overture but
managed to respond with, "IA's talk about it." She focused her
efforts toward the exploration of Ms. A's feelings and wishes in
detail to better understand what she was longing for, or perhaps,
protecting against with this overture. The symbolic significance
of this particular gift was explored as well.
28
The therapist found she initially felt anxious and then
annoyed. This overture felt like a setup for Ms. A to be
injured or for the therapist to be twisted into an
unacceptable position. What if the therapist disliked the
gift? Knowing the patient was easily injured and how
important her reactions were to her patient, could she
declare dislike? Perhaps the therapeutic stance was to
feign liking the item and mindfully wear it once or twice
a year? She did not think so. Clearly, she had little idea
what needs and affects were being negotiated here and
needed more information from Ms. A.
The therapist was worried about the likelihood of this
tuming out badly and hurting her patient or the
therapeutic relationship. The therapist found herself
feeling less and less like this was receiving a gift and
more and more like she was tiptoeing through a
minefield. She shared her worries and concerns openly
with Ms. A. Ms. A so appreciated the therapist's opinion
and affirmation. "How would you feel if I disliked the
jewelry? Would you feel that I disliked you?" How
would Ms. A feel about herself and the therapist if they
had different tastes in jewelry? Would she feel
diminished or hurt if the therapist was different from her
in this way? Ms. A seemed to be risking a degree of
vulnerability and intimacy she had never allowed herself
to experience before in a relationship. Ms. A
experienced herself as sturdy in this process, self-
knowing, and certain about her wishes and longings. She
wanted an honest response. The therapist, on the other
hand, felt anxious and confused about what would be
therapeutic in this case.
The therapist was now filled with countertransference
feelings that were discrepant from her patient's stated
experience. She was not convinced that Ms. A
would not be injured, despite her insistence.
Furthermore, she had trouble imagining speaking
the truth, particularly when she had no working
hypothesis for the therapeutic aim involved. As a
way to protect herself, the therapist remained
unhelpfully fixed on the request as a reenactment
of the faulty affective attunement and
attachments Ms. A had known as a child and
experienced throughout previous psychotherapy
experiences. Perhaps this was a repetition of
childhood disappointments with needed others?
Ms. A was undeterred despite her therapist's
limitations. She knew intuitively what she
needed from her therapist, even if she could not
articulate these feelings and issues so that her
therapist understood. She responded by pointing
out the therapist's unwillingness to have a truly
open dialogue and accused her of not taking
responsibility for her own feelings. She
commented, "You can't take the heat, so you're
leaving the kitchen." She smiled, warmly poking
fun at her therapist's dilemma.
She accurately perceived something about her
therapist. What was the therapist avoiding?
Perhaps the therapist was afraid of feeling
vulnerable, of disappointing or angering her
patient, or of closeness in the treatment
relationship? Her openness to one set of
transference-countertransference experiences was
a resistance to feeling a set of others. The

therapist did not fully understand her countertransference
reaction but was willing to be influenced and educated by her
patient. Coping with the unknown is a critical dimension of this
process. She felt the gift was a therapeutic opportunity that would
add a new, unknown dimension to the therapeutic relationship.
With uncertainty, she agreed to view and discuss Ms. A's gift.
Comforted by her faith in her patient's intuition and her belief
that an authentic response and conversation were
developmentally important to Ms. A, the therapist disclosed both
her worry and her best guess of what this interaction might mean.
She shared her concerns about injuring her patient, her faith in
her patient's intuition, and a belief that whatever the outcome,
they would negotiate the feelings together. The therapist viewed
the jewelry and offered these comments: "They're beautiful,
lovely, a work of art. It's easy to understand why you cherish
these pieces. They represent the history, color, and craftsmanship
of a country, which I know mean so much to you. While I think
they're beautiful, I would never wear them. Thank-you for
sharing these with me. How is it for you to hear me say this?"
The therapist felt trepidation as she offered Ms. A the
opportunity to engage in an exploration of the interpersonal and
intrapsychic meaning of this conversation and event. While Ms.
A may have been disappointed by her therapist's response, much
to her therapist's surprise and relief, the disappointment seemed
minor. Across the weeks to come, she and Ms. A continued to
explore the meaning and significance of this event and their
relationship.
Through sustained engagement with this
material, the therapist came to understand
that this overture was an invitation for more
intimacy in the therapeutic relationship. Her
patient needed and longed for an emotionally
honest response.
The interpersonal and intrapsychic exploration of
the associated feelings and the meaning of this event
to the therapist-patient dyad established a context
for safety that opened up space for a deeper, more
intimate conversation. Ms. A needed an honest,
authentic response so that she could own the
therapist's affirming, admiring feelings and
comments. If the therapist was to be deeply trusted
as an observer and allowed to influence Ms. A's
inner view of herself and her interpersonal view of
others, she needed to know the therapist was honest
and not simply being "therapeutic." Having worked
with this therapist twice weekly across many years,
Ms. A had a good sense of her therapist's style and
taste in clothing and jewelry. She had chosen an
item that she must have known would be other than
her therapist's style.
The therapist with Ms. A's help "structured a
process that opened up the moment and allowed for
deeper conversation, which enabled the patient to
begin to discover and utilize resources in herself
that she had never known" (Ehrenberg, 1995, p. 24).
This exploration helped Ms. A to shift her
idealization of her therapist and to understand she
Therapist's Self-Disclosure
had something important to offer her
therapist and her own treatment. This
therapeutic conversation consolidated the
patient's experience of the therapist as a new
object, different from her early childhood
objects, and enhanced the patient's
experience of the self as worthy of worry and
admiration. The effort to study the meaning
and qualities of mutual experience in this
moment created the space and conditions for
an intimate encounter, which would have
been impossible without an openness to self-
disclosure and a willingness to rely upon the
expertise of her patient (Ehrenberg, 1992;
Hoffman, 1983; Maroda, 1991, 1999a,
1999b; Stolorow et al., 1994). As this
vignette illustrates, the creation of meaning
in a therapeutic relationship is a shared
achievement (Ehrenberg, 1992; Hoffman,
1983).
Conclusions
Therapists are exploring in practice and in
the literature the usefulness of intentional
selfdisclosure in therapeutic relationships
(Anderson & Mandell, 1989; Aron, 1991;
Broucek & Ricci, 1998; Burke, 1992;
Cooper, 1998a, 1998b; Cornett, 1991;
Darwin, 1999; Ehrenberg, 1995; Epstein,
1995; Goldstein, 1994, 1997; Gorkin, 1987;
Greenberg, 1995; Jacobs, 1991; Lehrer,
1994; Levenson, 1996; Maroda, 1999b;
Mitchell, 1988; Modeli, 1991; Pizer,
1997; Raines, 1996; Renik, 1995;
Simon, 1988; Strean, 1997; Tansey &
Burke, 1989, 1991; Waska, 1999;
Wells, 1994; Wilkinson & Gabbard,
1993). An intersubjective relational
model that views the therapist as a full
participant in the cocreation of the
therapeutic relationship and
transference and an active player in the
unfolding of the inevitable relational
knots of an interpersonal
psychotherapy is a useful perspective.
This model invites the therapist's direct
use of her own affective and relational
experience with the patient as a means
to deepen therapeutic exploration and
understanding, introduce alternate
perspectives, and make conscious
material that will foster development
(Aron, 1991; Cooper, 1998b; Hoffman,
29
Nancy A. Bridges
1983, 1994; Maroda, 1991, 1999a, 1999b; Mitchell,
1988; Renik, 1991).
It is suggested that therapists who employ
selfdisclosure should monitor the influence of
selfinterest, remain patient focused, rely upon the
patient's resources and expertise, model emotional
honesty, and share their view of the clinical
relational experience. Anticipating and following
self-disclosure, therapists need to initiate
exploration of the multiple intrapersonal and
interpersonal meanings and effects upon the patient.
The therapist's intentional self-disclosure is an
essential, valuable therapeutic tool that deepens the
therapeutic conversation and relationship and leads
to unexpected, growth-fostering clinical
opportunities.
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