Shrink Rap News

The delicate balance of self-disclosure


When a doctor treats a patient – any patient, and perhaps psychotherapy patients in particular – there is one tenet that holds true for all visits: The visit is about the patient. Psychiatrists vary a great deal with respect to how much they reveal to patients about their personal lives. As the years have gone by, and we’ve talked more about controlled clinical trials and evidence-based medicine, we’ve talked less about boundaries and how much to disclose, or not, to patients about our personal lives.

I’m not a psychoanalyst. For them, boundaries about such things are clear, and self-disclosure about the therapist’s life is often taboo. Still, I do think it’s important to limit talking about oneself in psychotherapy for several reasons. For one thing, it takes up time that the patient could be using to do work and risks turning the session into a meeting that is about the therapist, and not the patient. And finally, having some distance keeps it clear that the relationship is a professional and therapeutic one, and not a friendship or romantic encounter, and that message hopefully is conveyed in a number of other ways as well.

I often tell people stories from my own life if I think it will convey a message or resonate for them: I may briefly talk about a movie I saw that pertains to the patient’s concerns or commiserate with them about life’s aggravations. My favorite story to tell patients who worry excessively that they might do something that will embarrass them, is that I once went to work at the clinic with my dress on inside out. Yes, it was immediately noticeable, but after my initial mortification and dash to the restroom, I was happy that I gave some kind social workers a good laugh. And life does go on, even after one embarrasses oneself. I share short stories that I hope will resonate, or give some perspective to an individual’s troubles, or simply let the patient know that we are all part of the same muck of humanity and things are not always easy.

What I don’t offer are stories that are very personal. I don’t talk about my children or husband, I don’t offer information about my health unless it’s absolutely necessary, the only relevant example being two pregnancies when I first started practicing.

But lives don’t always go smoothly. There was an unexpected death in my family a few weeks ago – the impetus for my thinking and writing about this topic now – and I felt I needed to offer an explanation to the patients I canceled on very little notice. It left those patients knowing that I’ve been struggling, though I am mostly able to put it aside while I work. Still, I feel badly that the patients have worried about me when they have their own difficulties.

The other day, the door of my suite bore a sign: One of my colleagues had a family emergency and requested that patients call to reschedule. I did learn that she had to run a sick child to the doctor, but I don’t know what she told those patients.

Although disclosing personal information can be distracting, or even disturbing, it seems reasonable to let patients know about emergencies that directly affect them. I long ago gave up on absolute answers to such questions; some patients press me for personal information and if it doesn’t feel overly intrusive, I simply respond and I don’t always ask why they want to know. When I do delve, sometimes the reasons reveal interesting information, but not always. Other patients never ask a thing. So while I have no answers but to say what has mostly worked for me, it somehow feels comfortable to revisit an old topic that doesn’t get much attention anymore.

Dr. Miller is coauthor of "Shrink Rap: Three Psychiatrists Explain Their Work" (Baltimore: Johns Hopkins University Press, 2011).

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