Self disclosure is a controversial topic which may divide analysts along theoretical lines. The “classical analyst” may regard self disclosure as a manifestation of counter-transference to be avoided, while the “inter-subjective analyst” may regard it as a useful tool. In comprising the COPE Study Group on Self Disclosure, the chairs' first task was to invite members who had no published position on the topic and were willing to consider all of their assumptions.
Self disclosure is a controversial topic which may divide analysts along theoretical lines. The “classical analyst” may regard self disclosure as a manifestation of countertransference to be avoided, while the “intersubjective analyst” may regard it as a useful tool.
The group posed a series of questions in their effort to move beyond judgment of self disclosure as either good or bad. Does the patient feel better or worse after a self disclosure and why? Does self disclosure lead to a more egalitarian experience for the patient? Does minimal self disclosure result in a more authoritarian experience for the patient? What motivates the analyst to self disclose? What is going on in the mind of the patient when we self disclose and what is going on in the mind of the analyst? What is happening in the psychoanalytic relationship when we self disclose? What is the effect of self disclosure on both analyst and patient?
The group began with the assumption that self disclosures are found in all analyses and could be studied within their own treatments. As group members presented clinical vignettes in which they self disclosed, it became less clear what constituted self disclosure because while some examples seemed obvious, others were not. Self disclosure seemed to be overde-termined, a resultant of forces going on in the mind of the analyst that might or might not be related to what is going on within the patient.
Self disclosure at times seemed to grow out of the analyst's experience of vulnerability. For example, the analyst discloses to the patient that he is ill. This might represent a wish to be taken care of by the patient, a way of warding off the patient's aggression, and/or necessary information that the patient needs in order to make other arrangements for treatment.
We found that self disclosures were sometimes determined by diagnostic considerations. For example, patients with problems in object constancy might be told that the analyst will be at a conference in New York City. This might help the patient to preserve an image of the analyst in time and space, and thereby facilitate rather than impede treatment. In fact, many of our clinical examples involved patients with more primitive character formations, prompting the observation that self disclosure may occur more commonly in this group of patients especially at times of crisis.
Regardless of diagnostic considerations, self disclosure seems to occur at critical junctures in a treatment and may serve to facilitate new ways of seeing and understanding. This may be so even when it seems to cut off negative transference or bypass analytic exploration.
The distinction between intentional and unintentional self disclosure was explored in its relationship to countertransference issues. We gave examples of both with a variety of outcomes within the treatment. While intentional self disclosures may be rationalized as being “good” for the patient and the process, both intentional and unintentional self disclosures clearly have unconscious determinants.
The group examined the relationship between self disclosure and dreams in which the analyst appears undisguised. Could these dreams be preceded by self disclosures in that day's session? We collected dreams and found some were related to self disclosure, others not; however, all seemed to be related to some disruption in the process.
The focus on self disclosure not only heightened our sensitivity to this specific issue, but more generally to the nature of interventions and their impact on patients. Any intervention reveals the state of mind of the analyst and how he conceptualizes the analytic space. One meaningful way of thinking about self disclosure is around issues of intimacy—how we communicate with patients so they can “hear” us.
The impact of the study group has extended beyond its members. One member is writing a paper on how self disclosure is handled in supervision. Another member conducted a workshop on self disclosure for faculty and candidates at his institute. A third member has a paper in press in which he advocates self disclosure at certain times. We have all incorporated the complexities of self disclosure in our teaching and supervision. We have all been much more open to discussing self disclosure with our supervisees and, in turn, our supervisees are much more comfortable in presenting examples of self disclosure in their supervision.
The group has found that an open and questioning attitude towards self disclosure is most beneficial. We urge all of you to participate in discussions of this issue with your colleagues without prior judgment or closure and to see where it takes you.
Members of the American Psychoanalytic Association interested in participating in COPE activities should contact COPE chair, Robert Michels.
Gerald Melchiode, M.D., is training and supervising analyst at the Dallas Psychoanalytic Center and clinical professor of psychiatry at Southwestern Medical College, Dallas. He co-chairs the COPE Study Group on Self Disclosure with Melvin Lansky.
Eslee Samberg, M.D., is editor of the COPE column.