Therapist self-disclosure: research-based suggestions for practitioners

Leading by example: Experimental evidence that therapist lived experience disclosures can model the path to recovery for clients

A common guideline for self-disclosure is that therapists should only share recovered personal experiences with clients (i.e., no longer distressing). However, theoretical rationale and empirical support for this claim is limited. Drawing on identity leadership theorizing, we investigated whether recovery disclosures are beneficial to the extent that they signal a therapist's aspirational prototypicality (i.e., embodiment of an aspirational identity for clients). Across two experimental studies (N = 545), we recruited clients, therapists and general population adults. Participants read a group therapy for depression vignette in which the therapist disclosed: nothing, professional experience with depression, current depression, recovered depression or recovered anxiety. Participants rated the prototypicality of the therapist, the extent to which they perceived the therapist positively, the therapist's expertness and the expected prognosis for therapy. Contrary to our hypotheses, the type of disclosure did not significantly affect positive perceptions, expertness or expected prognosis ratings. However, the therapist disclosing a recovered and relevant condition (recovered depression) was rated as significantly more aspirationally prototypical than the other therapists. Given prior evidence that group therapists are more effective when viewed as aspirationally prototypical, our findings suggest that recovery disclosures may represent one way therapists can signal their prototypicality and enhance their effectiveness.

Treating eating disorders by professionals with similar experiences: A systematic review

OBJECTIVE

Although a significant number of professionals who provide eating disorder (ED) treatment have lived experience with an ED in the past, there is no consensus on whether these professionals should use these experiences in treatment. This review aims to evaluate current literature on recovered professionals with an ED past treating ED patients, unravelling advantages and disadvantages in treatment, the impact on professionals and their surroundings, and implications for practice.

METHOD

A systematic literature search was conducted which included 10 articles. We analysed qualitative data through a systematic synthesis. Strength of evidence was calculated for each subtheme.

RESULTS

Three themes and 14 subthemes were divided into categories. The category 'treatment (patient-professional interaction)' was divided into: advantages, disadvantages and other implications for treatment. Additionally, the category 'professionals themselves' included subthemes that directly impact or relate to ED professionals: recovery as a non-linear process, the significant role of self-care and adverse feelings of professionals. Finally, the category 'work settings' included: company culture and training, supervision and professional development.

DISCUSSION

Recovered ED professionals are a promising addition to ED treatment due to the enhanced expertise of the professional. However, attention should be paid to the risk of distorted boundaries between patient and professional.

Facilitating transformative endings: Therapists' experience of ending therapy with people with intellectual disabilities-An interpretative phenomenological analysis

BACKGROUND

Endings in therapy are discussed widely in mainstream literature, however, there is only a small amount of research that considers endings in therapy for people with intellectual disabilities.

METHODS

Eight therapists were interviewed about their experience of ending therapy with people with intellectual disabilities. Interviews were analysed using Interpretative Phenomenological Analysis (IPA).

RESULTS

Four superordinate themes associated with endings that go well were identified: 'recognising', 'readying', 'reframing' and reflecting', with a fifth theme reflecting endings that were less successful. Participants worked hard to offer transformative experiences of endings and an overarching 'super-superordinate' theme of 'facilitating transformative endings' encompassed the findings.

CONCLUSIONS

Endings are a multi-faceted component of psychological therapy with people with intellectual disabilities and are significant for both client and therapist. We discuss implications for therapy adaptations and future research.

A Phenomenological Investigation into the Use of Therapist Self-disclosure in Compassion-Focused Therapy With Forensic Clients

Existing research has demonstrated the benefits of therapist self-disclosure (TSD) in strengthening therapeutic alliance. However, little is known about its effectiveness in the forensic context. The current research sought to address this gap by interviewing six Compassion Focused (CFT) therapists who had experience of working across a range of forensic settings. Results of an Interpretative Phenomenological Analysis (IPA) indicated that all participants advocated using TSD as a powerful therapeutic tool when working with forensic clients. However, there was a tension between balancing risk with the rewards of TSD, and participants expressed how the secure forensic environment was not conducive to its use. There was a consensus that TSD was more strongly discouraged with clients who had sexual convictions. For some, this had an impact on their own disclosures. Training on the function of TSD is recommended in forensic practice to address some of the environmental barriers to its implementation.

A quantitative survey measure of moral evaluations of patient substance misuse among health professionals in California, urban France, and urban China

BACKGROUND

The merits and drawbacks of moral relevance models of addiction have predominantly been discussed theoretically, without empirical evidence of these potential effects. This study develops and evaluates a novel survey measure for assessing moral evaluations of patient substance misuse (ME-PSM).

METHODS

This measure was tested on 524 health professionals (i.e., physicians, nurses, and other health professionals) in California (n = 173), urban France (n = 102), and urban China (n = 249). Demographic factors associated with ME-PSM were investigated using analyses of variance (ANOVAs) and t-tests, with results suggesting that ME-PSM is higher among younger health professionals, nurses (when compared with physicians and other health professionals), and Chinese health professionals (when compared with French and American health professionals).

RESULTS

Results provide preliminary support for the psychometric quality of the survey measure introduced in this study, including the existence of a single latent structure and partial invariance of collected data across countries.

CONCLUSION

The survey measure for ME-PSM which was developed and tested in the current study appears to hold potential utility for use as a measure of moral views of patient substance misuse. With development, this measure may be used to examine moral evaluations, both as factors of stigma and of other clinical factors associated with the treatment of patients with substance use disorders.

Facilitating dyadic synchrony in psychotherapy sessions: Systematic review and meta-analysis

Objective: This paper highlights the facilitation of dyadic synchrony as a core psychotherapist skill that occurs at the non-verbal level and underlies many other therapeutic methods. We define dyadic synchrony, differentiate it from similar constructs, and provide an excerpt illustrating dyadic synchrony in a psychotherapy session. Method: We then present a systematic review of 17 studies that have examined the associations between dyadic synchrony and psychotherapy outcomes. We also conduct a meta-analysis of 8 studies that examined whether there is more synchrony between clients and therapists than would be expected by chance. Results: Weighted box score analysis revealed that the overall association of synchrony and proximal as well as distal outcomes was neutral to mildly positive. The results of the meta-analysis indicated that real client-therapist dyad pairs exhibited synchronized behavioral patterns to a much greater extent than a sample of randomly paired people who did not actually speak. Conclusion: Our discussion revolves around how synchrony can be facilitated in a beneficial way, as well as situations in which it may not be beneficial. We conclude with training implications and therapeutic practices.

The global assessment of OCD

Obsessive Compulsive Disorder (OCD) is a common mental disorder that often causes great sufferance, with substantial impairment in social functioning and quality of life and affects family and significant relationships. Notwithstanding its severity, OCD is often not adequately diagnosed, or it is diagnosed with delay, leading often to a long latency between onset of the OCD symptoms and the start of adequate treatments. Several factors contribute to the complexity of OCD's clinical picture: early age of onset, chronic course, heterogeneity of symptoms, high rate of comorbidity with other psychiatric disorders, slow or partial response to therapy. Therefore, it is of primary importance for clinicians involved in diagnosing OCD, to assess all aspects of the disorder. This narrative review focuses on the global assessment of OCD, highlighting crucial areas to explore, pointing out the clinical features which are relevant for the treatment of the disorder, and giving an overview of the psychometric tools that can be useful during the screening procedure.

Taking the therapeutic community outside in the COVID-19 pandemic

Purpose

The COVID-19 pandemic has affected psychotherapy practice. A common change is a move to online sessions over video calls. In their therapeutic community (TC) for those with personality disorders, the authors have used video calls but not all clients could work in this way. The authors decided to meet patients outside and walked with them while adhering to government guidelines. This study aims to present the authors’ experience with one client who was interviewed afterwards about the experience.

Design/methodology/approach

A total of 10 walking therapy sessions of 60-min duration were conducted with the patient. After the sessions, both the patient and therapist were interviewed about their experience. The resulting interviews with both patient and therapist were thematically analysed independently by both authors.

Findings

There were common themes to both the client and therapist’s account following thematic analysis. These were: modelling and normalising in the real world, replacing what COVID-19 had taken away from the TC experience, changes at home, therapist disclosure, outcomes and good endings and being outside of the clinical environment.

Research limitations/implications

The authors have presented a single case of the patient and therapist experience of outdoor therapy sessions in a TC context response to the COVID-19 pandemic. The findings are not generalisable and can only provide a suggestion at the positive potential for working in this way. The authors hope that the positive effects of outdoor therapy noted here may inspire other clinicians to consider similar novel approaches in their work.

Originality/value

This study describes a novel way that a TC has adapted to the COVID-19 pandemic.

The nature, motives, and perceived consequences of therapist dishonesty

Honest communication between therapists and clients is an essential part of the process and values of psychotherapy, but the topic of therapist dishonesty has remained virtually unexplored. This study examined the prevalence, motivations, and perceived consequences of therapist dishonesty. Data were compiled from a Qualtrics survey, including several open-ended questions, of 401 practicing psychotherapists. Findings revealed that virtually all respondents acknowledged having been dishonest with their clients at least once, most often about their own emotional health and their attentiveness in session, and that they were significantly more likely to engage in covert than overt dishonesty. Most felt their dishonesty was in the service of their clients' therapy or wellbeing and perceived no negative consequences of such actions. Novice therapists reported being dishonest with their clients more frequently than therapists with more experience. Directions for future research, as well as the need for training programs to introduce students to this issue, are noted.

Defining self-disclosure of personal cancer coping experiences in oncology social workers' helping relationships: When cancer "hits home"

PURPOSE

Oncology social workers are increasingly finding themselves diagnosed with or caring for a loved one with cancer. Self-disclosure may be useful for building a therapeutic alliance. Yet, practice-informed guidelines for psychosocial oncology providers do not exist.

RESEARCH APPROACH

Twenty-three psychosocial oncology providers diagnosed with and/or providing care to someone with cancer completed semi-structured interviews eliciting attitudes and utilization regarding self-disclosure.

METHODOLOGICAL APPROACH

Interviews were digitally recorded and transcribed verbatim. Using grounded theory's constant comparative method, researchers conducted open and theoretical coding.

FINDINGS

Participants expressed consensus in defining, and reported a range of evolving practices regarding, self-disclosure. Recommendations for responsible self-disclosure included self-awareness, ongoing assessment, supervision, and enhanced educational programming.

INTERPRETATION AND IMPLICATION

Therapeutic tools must evolve as core features of psychosocial oncology care. A flexible and context-specific framework for clinician self-disclosure related to personal experiences with cancer can guide oncology social work practice.

When to disclose and to whom? examining within- and between-client moderators of therapist self disclosure-outcome associations in psychodynamic psychotherapy

Objective: While previous studies have indicated that therapists' self-disclosure (TSD) can have curative effects, the contextual variables that may moderate the link between TSD and treatment outcome have not been sufficiently explored. Using session-by-session psychotherapy data, we examined the extent to which within-client distress and between-clients emotion regulation difficulties moderated the associations between TSD and session outcomes.Method: The sample comprised 68 clients treated according to the principles of psychodynamic psychotherapy by 47 therapists in a university clinic. Emotion regulation difficulties were assessed at the beginning of treatment, and functioning and distress levels as well as symptoms were assessed at the beginning of each session. After each session, therapists completed a measure of frequency and centrality of their immediate and non- immediate self-disclosure interventions during the session.Results: At the within-client level, in sessions marked by high pre-session client distress, immediate TSD was associated with a better next session outcome. At the between-clients level, for clients who had low emotion regulation difficulties, immediate TSD was marginally associated with better outcomes.Conclusion: These findings highlight the importance of considering within-client level as well as between-clients level variables when deciding upon self-disclosure.

Using the Generic Model of Psychotherapy to Develop a Culturally-Sensitive Approach to Psychotherapy With Sexual and Gender Minority Patients

This article discusses how the Generic Model of Psychotherapy (Orlinsky and Howard, 1987) can help to organize the psychotherapy research and the knowledge in the field of psychotherapy for sexual and gender minority patients. The structure that this traditional model provides is a good foundation for research in this field, inasmuch as it stresses macrosocial aspects that determine the provision of psychotherapy and contextualize its outcomes. Each one of the main components offered by the Generic Model of Psychotherapy – Determinants, Processes, and Consequences – are specified for psychotherapy with LGBT patients and are illustrated with a selection of already existing research in the field of sexual minorities; they are also stress areas marked by knowledge gaps that require future developments. In addition, a set of questions are proposed to contribute to new studies, including the clinical implications that can be derived from this model.

A qualitative exploration of what works for migrant adolescents in transcultural psychotherapy: perceptions of adolescents, their parents, and their therapists

BACKGROUND

Migrant adolescents are at a higher risk than their native-born counterparts of psychiatric disorders, and their care is a public health issue. In France, transcultural psychotherapy is a treatment provided by a group of therapists designed to meet the specific needs of these patients when usual care appears ineffective. The objective of this study was to explore the therapeutic elements at work in transcultural psychotherapy.

METHODS

We conducted a qualitative study crossing the perspectives of adolescents receiving transcultural psychotherapy, their parents, their first-line therapist (FLT), and the transcultural therapists. The families were chosen by purposive sampling. Data were collected during semi-structured individual (for FLTs) and group (families and transcultural therapists) interviews that explored the therapeutic elements involved and effective in transcultural psychotherapy. We used interpretative phenomenological analysis (IPA) to examine the data. In all, 44 participants were questioned: three adolescents (2 girls and 1 boy, all aged 18 to 21 years) and their parents (3 mothers and 1 father), three FLTs (2 child psychiatrists and 1 psychologist), and the 34 therapists participating in the three transcultural psychotherapy groups.

RESULTS

The analysis uncovered three themes: (1) the perceived effectiveness of the group's functioning; (2) the recounting of the individual, family, and cultural history to allow for complexity and nuance; and (3) the personal investment by therapists, made possible by the group.

CONCLUSIONS

Our results show some therapeutic elements at work in transcultural psychotherapy that enable it to meet the particular needs of some migrant adolescents that are unmet in standard therapy. Continuing to study transcultural psychotherapy and assess its effectiveness is essential for promoting and optimizing psychiatric care for migrant adolescents.

Ethical Considerations for Treating the Old Order Amish

The Old Order Amish are the fastest growing religious subpopulation in the United States. The Amish population, most recently estimated at 340,000, is expected to double in size during the next 20 years. While still relatively few in number, their growing population and increasing interaction with American society will likely result in more Amish individuals seeking mental health treatment. Despite the call for culturally competent mental health professionals, this population has been underrepresented in the psychotherapy literature. To the best of the author's knowledge, this article is the first known attempt to review the ethical considerations that may arise when working with members of the Old Order Amish. This article uses the American Psychological Association's Ethical Principles of Psychologists and Code of Conduct to frame the discussion of ethical mental health treatment with Amish individuals.

Career Counselors Self-Disclosing to First-Generation College Students: A Grounded Theory Study

Financial security is cited among reasons why first-generation college students (FGCS) pursue higher education, yet the literature advocating the pursuit of a bachelor’s degree for its perceived value in the employment marketplace fails to include the need for career exploration and planning during the college years. The purpose of this grounded theory study was to examine how career counselors who had been the first in their families to go to college use their personal experience to support current FGCS. The findings of the study suggest that career counselors who share personal, relevant stories from their own college experiences can counter students’ feelings of isolation and confusion regarding career exploration and planning. Further, findings suggest that career counselors who actively partner with academic and student life colleagues on their campuses help FGCS students form a network of contacts, subsequently creating equitable social capital opportunities for all students.

Therapist self-disclosure and the problem of shared-decision making

Therapist self-disclosure is one of the most controversial topics in the history of psychotherapy. The controversies reflect some basic discussions regarding the nature of psychotherapy practice. In psychotherapy practice, a particular concern is the interaction between the psychotherapist and the patient. The expert-patient interaction has been addressed in a novel framework for clinical practice called shared-decision making. In this paper, we discuss the relationship between self-disclosure and shared-decision making. The chief aim is to illustrate some of the principles and practical problems with shared-decision making by using therapist self-disclosure as an example.

The Predictive Role of Positive Mental Health for Attitudes Towards Suicide and Suicide Prevention: Is the Well-Being of Students of the Helping Professions a Worthwhile Goal for Suicide Prevention?

This study evaluates the potential value of eudaimonic well-being in assessing pro-preventive orientation towards suicide and recognizing suicide as a solution. The aim was to integrate positive and negative conceptualizations of mental health for predicting attitudes towards suicide, and towards suicide prevention, among students of the helping professions. The study participants (166 women and 73 men, mean age 22.84 ± 5.15) answered a set of questionnaires, including a Questionnaire on Attitudes Towards Suicide, Goldberg Health Questionnaire (GHQ-28), Psychological Well-Being Scale (PWB-42) and Centrality of Religiosity Scale. Multiple regression analysis showed that environmental mastery, purpose in life and positive relationships, controlled for religiousness and psychological problems related to general mental health, predicted the variability of attitudes towards suicide and pro-preventive orientation. Sociodemographic variables were not related to attitudes towards suicide. Our findings suggest that positive mental health, represented jointly by low mental health problems and eudaimonic components of happiness, plays a role in predicting pro-preventive attitudes. Therefore, improving positive mental health among students in the helping professions, these being the future gatekeepers, could be considered an auxiliary strategy for suicide prevention.

Opening up while locked down: Client disclosure in correctional settings

Incarcerated individuals experience mental health symptoms resulting from the stress of incarceration, as well as from prior histories of trauma. In addition, the growth of the prison population and the increase in sentence lengths have eroded conditions in correctional facilities, leading to increased stress, trauma, and other mental health issues. Psychologists can help incarcerated individuals address existing mental health issues, cope with the trauma of incarceration, and prepare for successful re-entry into society. However, the effectiveness of psychotherapy may be hampered by a number of factors that inhibit client disclosure in correctional settings. Based on interviews with forensic psychologists and an incarcerated patient, this paper explores the circumstances that prevent disclosure in correctional settings and proposes recommendations for psychologists to facilitate disclosure to improve therapeutic effectiveness.

The therapist's dilemma: Tell the whole truth?

Honest communication between therapist and client is foundational to good psychotherapy. However, while past research has focused on client honesty, the topic of therapist honesty remains almost entirely untouched. Our lab's research seeks to explore the role of therapist honesty, how and why therapists make decisions about when to be completely honest with clients (and when to abstain from telling the whole truth), and the perceived consequences of these decisions. This article reviews findings from our preliminary research, presents a case study of the author's honest disclosure dilemma, and discusses the role of therapeutic tact and its function in the therapeutic process.

"It is OK to let them know you are human too": Mentor self-disclosure in formal youth mentoring relationships

This study aims to capture descriptive data on how mentors self-disclose to their adolescent mentees. Self-disclosure is a normative communication process that facilitates trust and closeness in interpersonal relationships. Despite being a relational intervention, little is known about self-disclosure in youth-mentoring relationships. A total of 54 mentors from 2 community-based mentoring programs in Auckland, New Zealand, participated in this mixed-methods study about their experiences of disclosing to mentees via an online questionnaire. In this sample, mentors disclosed about various topics, including hobbies, school and work, health, beliefs, self-esteem, substance use, emotions, sex, and money. Qualitative analysis identified themes regarding how mentors self-disclose, disclosure influencing positive relationship characteristics, the influence of mentoring programs, challenges with mentee interest and culture clashes, and the perceived effect of self-disclosure on mentees and the mentoring relationship. These mentors disclosed broadly and viewed generally self-disclosure in a positive way, but they also experienced challenges and complexities.

The "me too" decision: An analog study of therapist self-disclosure of psychological problems

OBJECTIVES

To test the exploratory hypothesis that client perceptions of therapists are most favorable when therapists self-disclose their own personal experience with the same psychological problem to a moderate (vs. none, mild, or extreme) extent.

METHOD

Undergraduate participants (N = 104; 63.5% female) were randomly assigned to read one of the four vignettes, which differed only in the extent to which the therapist disclosed their own personal experience with the same presenting problem (none, mild, moderate, or extreme). Participants then responded to questions assessing their perceptions of the therapist.

RESULTS

The data generally supported the hypothesis. The moderate disclosure condition yielded the most favorable client perceptions, which differed significantly from those yielded by the no disclosure condition.

CONCLUSIONS

Despite limitations and need for replication, this study provides perhaps the first empirical data regarding the effect of the extent, rather than the mere presence or absence, of therapist self-disclosure regarding personal psychological experiences.

Self-Disclosure in Criminal Justice: What Form Does It Take and What Does It Achieve?

Self-disclosure, the act of therapists revealing something about themselves in the context of a professional relationship, has been linked with higher levels of effectiveness when used by correctional workers. However, it is poorly defined in both criminal justice policy and criminological research which has resulted in a lack of understanding about the potential risks and benefits to practice and practitioners. This article uses literature from other fields (namely, social work, counselling, and psychotherapy) to lay out what forms self-disclosure might take in the field of criminal justice. The article presents data that were generated as part of a larger project on emotional labour in probation practice in England. It analyses these data to argue that self-disclosure is used in two principle ways: to create and enhance a therapeutic relationship and in a more correctional way which is focused on criminogenic risk and need. We conclude by arguing that future research which seeks to identify a link between certain skills and effective outcomes needs to start with a much stronger definition of such skills as, otherwise, any effects are likely to be lost.

"It's both a strength and a drawback." How therapists' personal qualities are experienced in their professional work

Objective: The aim of this study was to gain knowledge about how the integration of personal and professional experiences affects therapeutic work. Method: Therapists (N = 14) who had been recommended by their leaders at their individual workplaces were interviewed twice with semi-structured qualitative interviews, which were then subjected to thematic and Interpretative Phenomenological Analysis. Results: All the therapists in the sample described their personal qualities as an experienced tension between their personal strengths and vulnerabilities in the therapeutic setting. This tension came to expression through four subordinate themes: (a) The tension between perceiving oneself as a helper while dealing with one's own needs for attention and care; (b) The tension between the ability for embodied listening to the patient while tuning into oneself; (c) The tension between staying present while handling aggression and rejection from clients; and (d) The tension in striving for a constructive balance between closeness and distance. Conclusion: The results point to ways in which the personal selves of the therapists may affect their professional role performance. Drawing upon previous research and literature on the topic, the paper discusses how therapists' personal qualities are experienced as affecting their work and suggests several implications for psychotherapy training and practice.

Behind the Scenes of Online Therapeutic Feedback in Blended Therapy for Depression: Mixed-Methods Observational Study

BACKGROUND

In Internet-delivered cognitive behavioral therapies (iCBT), written feedback by therapists is a substantial part of therapy. However, it is not yet known how this feedback should be given best and which specific therapist behaviors and content are most beneficial for patients. General instructions for written feedback are available, but the uptake and effectiveness of these instructions in iCBT have not been studied yet.

OBJECTIVE

This study aimed to identify therapist behaviors in written online communication with patients in blended CBT for adult depression in routine secondary mental health care, to identify the extent to which the therapists adhere to feedback instructions, and to explore whether therapist behaviors and adherence to feedback instructions are associated with patient outcome.

METHODS

Adults receiving blended CBT (10 online sessions in combination with 5 face-to-face sessions) for depression in routine mental health care were recruited in the context of the European implementation project MasterMind. A qualitative content analysis was used to identify therapist behaviors in online written feedback messages, and a checklist for the feedback instruction adherence of the therapists was developed. Correlations were explored between the therapist behaviors, therapist instruction adherence, and patient outcomes (number of completed online sessions and symptom change scores).

RESULTS

A total of 45 patients (73%, 33/45 female, mean age 35.9 years) received 219 feedback messages given by 19 therapists (84%, 16/19 female). The most frequently used therapist behaviors were informing, encouraging, and affirming. However, these were not related to patient outcomes. Although infrequently used, confronting was positively correlated with session completion (ρ=.342, P=.02). Therapists adhered to most of the feedback instructions. Only 2 feedback aspects were correlated with session completion: the more therapists adhere to instructions containing structure (limiting to 2 subjects and sending feedback within 3 working days) and readability (short sentences and short paragraphs), the less online sessions were completed (ρ=-.340, P=.02 and ρ=-.361, P=.02, respectively). No associations were found with depression symptom change scores.

CONCLUSIONS

The therapist behaviors found in this study are comparable to previous research. The findings suggest that online feedback instructions for therapists provide sufficient guidance to communicate in a supportive and positive manner with patients. However, the instructions might be improved by adding more therapeutic techniques besides the focus on style and form.

Patients' perspectives on political self-disclosure, the therapeutic alliance, and the infiltration of politics into the therapy room in the Trump era

The primary aim of this study was to investigate the effects of the 2016 United States presidential election and ensuing political climate on patients' experiences in psychotherapy. A sample of 604 self-described Democrat and Republican patients from 50 states participated in the study. Results showed that most therapists disclosed their political stance (explicitly or implicitly) and most patients discussed politics with their therapists. 64% of Clinton supporters and 38% of Trump supporters assumed political similarity with their therapist. Stronger patient-reported alliance levels were found for patients who (a) perceived political similarity; (b) reported implicit therapist political disclosure; and (c) found in-session political discussions helpful. Additionally, Clinton (but not Trump) supporters reported significant pre-post-election decreases in expression of positive emotions and increases in both expression of negative emotions and engagement in discussions about socio-political topics. Our findings suggest that the current political climate infiltrates the therapeutic space and affects therapeutic process and content.

"Clowns to the left of me, jokers to the right": Politics and psychotherapy, 2018

The election and postelection policies of Donald Trump have seeped into the psychotherapy sessions of many clients, in ways that are somewhat unique but also somewhat reminiscent of the ways that other dramatic social-political events, including 9/11 and the social divisions that were characteristic of the 1960s, were brought into the treatment room. The nine articles within this issue-seven papers from practicing psychotherapists, one from an executive coach, and one empirical paper-suggest strongly that the political events surrounding the election of 2016 have become a significant part of psychotherapeutic discourse for many clients, that many therapists have been willing participants in such discussions, and that a focus on political issues (broadly speaking) can have important clinical benefits, facilitating the therapeutic alliance and leading to greater understanding of long-standing client problems and interpersonal functioning. Taken together, these papers lead to the conclusion that, at a minimum, clinicians need to be sensitive to the very real possibility that their clients are acutely aware of and affected by the political events surrounding the 2016 presidential election and may welcome open discussion of these events and their consequences.

Therapeutic Self-Disclosure within DBT, Schema Therapy, and CBASP: Opportunities and Challenges

In recent years, various therapeutic interventions have been established that extended behavior and cognitive behavior therapy (CBT) by so-called "third-wave" strategies. In order to address specific therapeutic challenges in certain subgroups of patients who do not sufficiently respond to "classical CBT," some of these third-wave strategies put particular emphasis on therapist self-disclosure. This article highlights therapeutic self-disclosure as a means to address interpersonal problems by comparing three third-wave strategies: (a) acceptance and change strategies as used in Dialectical Behavioral Therapy (DBT), (b) the concept of "limited reparenting" as used in Schema Therapy (ST), and (c) disciplined personal involvement as used in the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). On the basis of a critical discussion on opportunities and challenges within these three concepts, self-disclosure is proposed to be a promising therapeutic tool that is worth to be investigated in more depth in future studies.

Physician self-disclosure in primary care: a mixed methods study of GPs' attitudes, skills, and behaviour

BACKGROUND

There is a debate in medicine about the use and value of self-disclosure by the physician as a communication tool. There is little empirical evidence about GPs and self-disclosure.

AIM

To explore what GPs' attitudes, skills, and behaviour are with regard to self-disclosure during a clinical consultation and whether there is a need for the development of training resources.

DESIGN AND SETTING

Mixed methods using open-ended and semi-structured interviews in Auckland, New Zealand, and the surrounding districts.

METHOD

Sixteen GPs were interviewed on the issue of self-disclosure in clinical practice. A general inductive approach was used for data analysis.

RESULTS

Self-disclosure was common in this group of GPs, contrary to training in some of the groups, and was seen as a potentially positive activity. Family and physical topics were most common, yet psychological and relationship issues were also discussed. Knowing patients made self-disclosure more likely, but a GP's intuition played the main role in determining when to self-disclose, and to whom. GPs have developed their own guidelines, shaped by years of experience; however, there was a consensus that training would be helpful.

CONCLUSION

Self-disclosure is common and, in general, seen as positive. Major personal issues were acceptable for some GPs to self-disclose, especially to known patients. Although participants had developed their own guidelines, exposure of trainees to the issue of self-disclosure would be of value to prevent future mistakes and to protect both doctor and patient from any unintended harm, for example, developing a dependent relationship.

(What) do you believe?: Therapist spiritual/religious/non-religious self-disclosure

OBJECTIVE

Spiritual/religious/non-religious (S/R/N) identity development is often neglected in psychotherapy training and represents an area where psychotherapists feel they lack competence. Such feelings can become even more pronounced when it comes to S/R/N self-disclosure. This study explores the decisions therapists make regarding self-disclosure, which impacts the psychotherapy process.

METHOD

This grounded theory study explores psychotherapists' S/R/N self-disclosure based on qualitative interviews with 21 psychotherapists representing varied theoretical orientations and spiritual, religious, atheist, and agnostic backgrounds.

RESULTS

Findings reveal that while some self-disclosure happens on an explicit level, more often psychotherapists find implicit ways to share S/R/N aspects of the self for purposes of enhancing the therapeutic alliance and to convey openness. Psychotherapists also attempt to avoid the topic altogether, either to protect the therapeutic relationship or because of unresolved S/R/N identity in the therapist.

CONCLUSIONS

Developing skills related to S/R/N self-disclosure represents an important aspect of multicultural competence, which can impact clients' feelings of safety and comfort discussing their own S/R/N identity. This capacity is strongly influenced by the therapist's self-awareness regarding S/R/N identity. Suggestions for engaging S/R/N identity and disclosure in supervisory experiences and academic preparation are discussed.

Do Patients Look Up Their Therapists Online? An Exploratory Study Among Patients in Psychotherapy

BACKGROUND

The use of the Internet as a source of health information is growing among people who experience mental health difficulties. The increase in Internet use has led to questions about online information-seeking behaviors, for example, how psychotherapists and patients use the Internet to ascertain information about each other. The notion of psychotherapists seeking information about their patients online (patient-targeted googling, PTG) has been identified and explored. However, the idea of patients searching for information online about their psychotherapists (therapist-targeted googling, TTG) and the associated motives and effects on the therapeutic relationship remain unclear.

OBJECTIVE

This study investigated former and current German-speaking psychotherapy patients' behavior and attitudes relating to TTG. In addition, patients' methods of information gathering, motives, and success in searching for information were examined. Furthermore, patients' experiences and perceptions of PTG were explored.

METHODS

Overall, 238 former and current psychotherapy patients responded to a new questionnaire specifically designed to assess the frequency, motives, use, and outcomes of TTG as well as experiences and perceptions of PTG. The study sample was a nonrepresentative convenience sample recruited online via several German-speaking therapy platforms and self-help forums.

RESULTS

Of the 238 former and current patients who responded, 106 (44.5%) had obtained information about their therapists; most of them (n=85, 80.2%) had used the Internet for this. Besides curiosity, motives behind information searches included the desire to get to know the therapist better by attempting to search for both professional and private information. TTG appeared to be associated with phases of therapy in which patients felt that progress was not being made. Patients being treated for personality disorders appear to engage more frequently in TTG (rphi = 0.21; P=.004). In general, however, information about therapists sought for online was often not found. Furthermore, most patients refrained from telling their therapist about their information searches.

CONCLUSIONS

Patients appear to engage in TTG to obtain both professional and private information about their psychotherapists. TTG can be viewed as a form of client-initiated disclosure. It is therefore important to include TTG as a subject in therapists' education and also to raise awareness within patient education. This investigation provides the first findings into TTG to begin debate on this subject.

Considerations for Culturally Responsive Cognitive-Behavioural Therapy for Māori With Depression

A strong case can be made for adapting cognitive-behavioural therapy (CBT) for ethnic and cultural minority groups. In North America, literature is readily available for CBT practitioners wishing to adapt their practice when working with ethnic minority groups (e.g., Latino, African-American, and Native American groups). In other countries such as New Zealand, literature of this sort is scarce, and the empirical foundation for CBT adaptation in these parts of the world is weak. This article documents the core tenets of an empirically validated CBT treatment protocol tailored for individual delivery to Māori clients suffering from depression in New Zealand and developed through consultation with an expert advisory group consisting of senior clinicians and Māori cultural experts. The result is a series of considerations for clinicians endeavouring to provide culturally responsive CBT with Māori clients, who are identified and organised into four domains. Two case studies are presented to illustrate the practical application of the proposed techniques. Links are made to international literature related to the adaptation of CBT in pursuit of cultural responsiveness.

Culturally adapted cognitive behaviour therapy for Māori with major depression

Māori are the indigenous people of New Zealand and in 2006 comprised approximately 15% of the country's population. Epidemiological data suggests Māori experience rates of depression that are higher than the general population and are less likely to engage in treatment for mental health issues. The main aim of this study was to evaluate the effectiveness of an adapted approach to psychotherapy with Māori. The broad goals of which were to provide empirically grounded guidance for therapists aspiring to provide best practice to their Māori clients. This paper documents the evaluation of a cognitive behavioural therapy (CBT) treatment protocol specifically designed and adapted for delivery to adult Māori clients with a diagnosis of depression. The treatment protocol was administered to 16 Māori clients with a primary diagnosis of depression. The adapted treatment incorporated Māori processes for engagement, spirituality, family involvement and metaphor. The intervention exhibited considerable promise with large significant reductions in depressive symptomatology in the participant group. Furthermore, significant reductions in negative cognition were observed. This is the first piece of applied clinical research that has examined the effectiveness of an individual psychological therapy exclusively with Māori and the first to examine individual psychotherapy outcomes with an indigenous population using an effectiveness study. The findings have a number of implications for the treatment of Māori clients with depression. This study provides useful guidelines for clinicians providing psychological treatment to Māori and provides strong support for the cultural adaptation of psychological treatment with ethnic minority groups.