Therapist self-disclosure in cognitive-behavior therapy

Exploring the Use of the Therapist's Self in Therapy: A Systematic Review

Purpose

This systematic qualitative review explored how psychotherapists use their self in therapy within the psychotherapy literature. It sought to examine the key documented ways through which the therapist's self is intentionally used in therapy and the process of using the therapist's self.

Methods

Following PRISMA guidelines, databases including PubMed, ProQuest, APA PsycArticles, and APA PsycINFO were searched. The review question "How do therapists use their self in therapy?" guided the search using derivative keywords. Of the 149 screened articles, 20 underwent full-text review, and only four studies met inclusion criteria.

Findings

All studies that met the inclusion criteria were from the West. Therapeutic self-disclosure (TSD) emerged as the primary way through which therapists used their self in therapy-notably, the only way documented in the studies reviewed. Studies discussed the nature, rationale, influencing factors, and effectiveness of TSD. This article elaborates upon the themes from the reviewed studies. It critically examines existing literature, lists avenues for future research, and discusses implications for psychotherapy practice.

Conclusions

The review underscores a significant gap in empirical qualitative research regarding therapists' use of their self beyond TSD in therapy. There is an urgent need for further exploration in this domain.

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.

What Chinese Women Seek in Mental Health Apps: Insights from Analyzing Xiaohongshu User Posts during the COVID-19 Pandemic

Gender disparity poses a prominent obstacle to achieving effective mental health outcomes in digital healthcare. Despite women being more inclined to use mental health apps and seeking designs tailored to their specific needs, there is limited research on the factors influencing female users' engagement with these apps. The COVID-19 pandemic has further exacerbated its disproportionate impact on women's mental health. This study investigates female users' posts (n = 5538) about mental health apps during the pandemic, using data collected via a Python web crawler from Xiaohongshu, a popular female-centric social media platform in China. A mixed-methods approach used qualitative thematic analysis and quantitative descriptive statistics. Among these posts, therapeutic functionality emerged as the highest priority, followed by credibility and user experience, with specific design elements highlighted as particularly significant. These findings provide valuable insights for mental health researchers and developers, including you, aiming to create gender-tailored mobile solutions to address the mental health challenges faced by women, especially during future pandemics.

What to take up from the patient's talk? The clinician's responses to the patient's self-disclosure of their subjective experience in the psychiatric intake interview

During psychiatric diagnostic interviews, the clinician's question usually targets specific symptom descriptions based on diagnostic categories for ICD-10/DSM-5 (2, 3). While some patients merely answer questions, others go beyond to describe their subjective experiences in a manner that highlights the intensity and urgency of those experiences. By adopting conversation analysis as a method, this study examines diagnostic interviews conducted in an outpatient clinic in South Finland and identifies sequences that divulge patients' subjective experiences. From 10 audio-recorded diagnostic interviews, 40 segments were selected where patients replied to medically or factually oriented questions with their self-disclosures. The research focus was on the clinicians' responses to these disclosures. We present five sequential trajectories that the clinicians offered third-position utterances in response to their patients' self-disclosure of subjective experiences. These trajectories include the following: 1) the clinician transfers the topic to a new agenda question concerning a medical or factual theme; 2) the clinician presents a follow-up question that selects a topic from the patient's self-disclosure of a subjective experience that may orient either towards the medical/factual side or the experiential side of the patient's telling; 3) the clinician provides an expert interpretation of the patient's self-disclosure of his or her subjective experience from the clinician's expert perspective; 4) the clinician gives advice that orients mainly to a treatment recommendation or to another activity; and 5) the clinician presents a formulation that focusses on the core of their patient's self-disclosure of his or her subjective experience from the patient's perspective. In addition, we present what these responsive practices invoke from the patient in the next turn. We argue that an awareness of these strategies facilitates both the diagnosis and an appropriate therapeutic relationship during the psychiatric assessment interview. Finally, we discuss the clinical significance of our results regarding the patient's agency and the clinician's more conscious patient-centred orientation in the psychiatric assessment procedure.

Skill Use Mediates the Within-Person Effect of the Alliance on Session-to-Session Changes in Anxiety and Depression in the Unified Protocol

Objective

Both the therapeutic alliance and the specific skills taught in treatment are thought to contribute to change in cognitive-behavior therapy (CBT), but it is unclear if or how these processes influence each other and outcomes in treatment. We tested the hypothesis that the degree to which patients used CBT skills would mediate the relation between the alliance and session-to-session changes in anxiety and depression.

Method

Adult participants (N = 70; Mage = 33.74, 67% female, 70% White) with emotional disorders were randomized to receive 6 or 12 sessions of the Unified Protocol. Before each session, participants reported anxiety and depression severity and past-week skillfulness. After each session, participants rated the strength of the alliance. We tested whether greater within-person skillfulness mediated the relation between within-person alliance strength and session-to-session changes in anxiety and depression.

Results

Skillfulness significantly mediated the effect of the alliance on session-to-session changes in anxiety, ab = -.02, p = .04, and depression, ab = -.02, p = .02, such that a stronger alliance predicted greater next-session skillfulness, which predicted session-to-session decreases in anxiety and depression. When alliance subscales were examined separately, the strongest effect was observed for agreement on therapy tasks.

Conclusions

Improvements in the alliance may facilitate skill use and indirectly predict reductions in anxiety and depression through skill use in CBT. We encourage research on how to enhance both the alliance and skillfulness in CBT.

Parent Involvement in Mental Health Treatment for Autistic Children: A Grounded Theory-Informed Qualitative Analysis

Cognitive behavior therapy (CBT) is an effective treatment for many autistic children experiencing mental health problems, and parents are particularly involved in their psychotherapy. This study presents a conceptual framework of successful parent involvement in CBT for autistic children. Seventeen therapists (94% female) and 11 mothers were interviewed about their involvement in a CBT program for autistic children ages 8-13 years. The conceptual framework depicts how parent involvement varies depending on child, parent, and environmental factors. Parents' contributions to therapy were grouped into five main roles. Parents' beliefs and attitudes toward therapy also influenced their involvement. This is the first study to empirically investigate how parents of autistic children contribute to the therapeutic process in CBT.

Therapist self-disclosure in teletherapy early in the COVID-19 pandemic: Associations with real relationship and traumatic distress

The usefulness of therapists' self-disclosure (TSD) in psychotherapy remains controversial, and little is known regarding the potential risks and benefits of TSD in times of global crisis such as the COVID-19 pandemic and in teletherapy. We examined two independent samples of therapists (N = 1705; Study 1) and patients (N = 772; Study 2) on their perceptions of increases in TSD during the transition to teletherapy early in the COVID-19 pandemic (spring 2020). Approximately 20% of therapists and 14% of patients reported perceptions of definite increases in TSD. Therapists' top reasons for increased TSD were therapists' heightened distress and an effort to connect with patients in teletherapy. Importantly, therapist perceptions of their increased TSD were positively related to subjective vicarious trauma, real relationship, psychodynamic theoretical orientation and negatively with humanistic orientation, but not with age, race/ethnicity, length of clinical experience, working alliance, or professional self-doubt. Patients' perceptions of increased TSD were positively related with patient pandemic-related traumatic distress and their own self-disclosure, but not with patient-reported therapeutic relationship variables. Longitudinally, patients' perceptions of TSD increases predicted higher pandemic-related traumatic distress at 3-month follow-up, after controlling for their baseline traumatic distress and other variables. These results highlighted that increased TSD in teletherapy may be a potential marker for heightened distress in both patients and therapists during a global crisis and a transition to teletherapy. The findings also contrasted the literature and emphasized that therapists, but perhaps not patients, may have considered increased TSD as a reflection of genuine therapeutic connection.

Socioeconomic status and the therapeutic alliance: An empirical investigation using structural equation modeling

OBJECTIVE

The purpose of the study was to investigate the associations between client socioeconomic status and the therapeutic alliance.

METHODS

Data on socioeconomic status and different aspects of the therapeutic alliance were obtained from participants currently or recently in psychotherapy and analyzed using structural equation modeling.

RESULTS

The results provided support for a structural equation model where socioeconomic status was positively related to the therapeutic alliance. The study also found that the associations between socioeconomic status and therapeutic alliance was significantly stronger among clients who had received psychodynamic therapy compared to those who had received cognitive behavior therapy.

CONCLUSIONS

The results are discussed in relation to research suggesting that clients of lower socioeconomic status are estranged from the psychotherapeutic context, reflecting experiences among the clients both of not being understood and as inferior in relation to their therapist, as well as possible perceptions that such client are less suitable for psychotherapy.

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.

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.

Cultural adaptations of CBT: a summary and discussion of the Special Issue on Cultural Adaptation of CBT

Cognitive behavioural therapy (CBT) in its current form might not be acceptable to service users from a variety of backgrounds. Therefore, it makes sense to adapt CBT when working with diverse populations. Contributors to this special issue of theCognitive Behaviour Therapisthave tackled the issues around the cultural adaptation of CBT from various perspectives, using a variety of methods, and have addressed topics ranging from cultural adaptation to improving access to CBT. Here, I briefly summarize and discuss the papers in this special issue. I start with a systematic review of CBT for social anxiety across cultures. Seven articles cover aspects of adaptation of therapies for people from different backgrounds. Three papers discuss the issues of gender and sexuality when using CBT, while another three papers focus on refugees, asylum seekers and the homeless, and two papers describe the application of CBT with religious populations. Finally, there are seven papers on issues related to service delivery, practice and training and supervision when working with a diverse population. Collectively, papers in this special issue provide us with sufficient evidence that cultural considerations play a vital role when using CBT, offer practical suggestions for improving cultural competence and most importantly, can catalyse future research. However, the full potential of culturally adapted interventions will not be realized until and unless access to CBT is improved. Therefore, there is a need to build robust evidence to convince funders, policy makers and service managers.

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.

Manifestações Emocionais do Terapeuta Durante as Sessões: Por que Arriscar-se e Quais Benefícios Esperar?

Resumo A teorização contemporânea enfatiza o envolvimento emocional do terapeuta no relacionamento terapêutico. O objetivo desse estudo é compreender como esse envolvimento se dá na prática clínica e por que terapeutas escolham esse caminho. Foi desenvolvido um estudo a partir de entrevistas a 14 terapeutas, com perguntas sobre como utilizam suas emoções em sessão e quais benefícios visam com essa ação. A análise e categorização dos dados encontrados foram pautadas nos preceitos da Grounded Theory Analysis. Os resultados sugerem que terapeutas expõem suas emoções em sessão com objetivo de diagnóstico e como intervenção terapêutica, promovendo comportamentos alvo e maior consciência de processos interpessoais no cliente. Para o terapeuta, trabalhar com suas emoções pode acarretar em transformações tanto pessoais quanto profissionais. Em uma relação emocionalmente próxima, aberta e genuína no consultório, não só o cliente, mas também o terapeuta é transformado. Assim, a mudança que ocorre no processo terapêutico não deve ser pensada como um processo unilateral.

Culture and therapist self-disclosure

Cognitive behaviour therapy (CBT) as a treatment for schizophrenia and psychotic-related disorders has been shown to have significantly greater drop-out rates in clients of black and minority ethnic (BME) groups. This has resulted in poor outcomes in treatments. Our recent qualitative study thus aimed to develop culturally sensitive CBT for BME clients. The study consisted of individual in-depth 1:1 interviews with patients with a diagnosis of schizophrenia, schizo-affective, delusional disorders or psychosis (n = 15) and focus groups with lay members (n = 52), CBT therapists (n = 22) and mental health practitioners (n = 25) on a data set of 114 participants. Several themes emerged relating to therapist awareness on culturally derived behaviours, beliefs and attitudes that can influence client response and participation in therapy. The current paper aims to explore one of these themes in greater detail, i.e. client-initiated therapist self-disclosure (TSD). Using thematic analysis, the paper highlights key elements of TSD and how this could impact on therapist’s reactions towards TSD, the therapeutic alliance and ultimately, the outcomes of therapy. The findings appear to show that TSD has significant relevance in psychological practice today. Some BME client groups appear to test therapists through initiating TSD. It is not the content of TSD they are testing per se, but how the therapist responds. Consequently, this requires therapists’ cognisance and sensitive responses in a manner that will nurture trust and promote rapport. Further investigation in this area is suggested with a recommendation for guidelines to be created for clinicians and training.

Key learning aims

(1)

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.

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.

Therapist self-disclosure and the therapeutic alliance in the treatment of eating problems

Evidence is mixed regarding the potential utility of therapist self-disclosure. The current study modelled relationships between perceived helpfulness of therapist self-disclosures, therapeutic alliance, patient non-disclosure, and shame in participants (n = 120; 95% women) with a history of eating problems. Serial multiple mediator analyses provided support for a putative model connecting the perceived helpfulness of therapist self-disclosures with current eating disorder symptom severity through therapeutic alliance, patient self-disclosure, and shame. The analyses presented provide support for the contention that therapist self-disclosure, if perceived as helpful, might strengthen the therapeutic alliance. A strong therapeutic alliance, in turn, has the potential to promote patient disclosure and reduce shame and eating problems.

(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.

Cognitive Behavioral and Psychodynamic Therapies: Points of Intersection and Divergence

Cognitive behavioral therapy (CBT) and psychodynamic therapy (PDT) are two major paradigms in the mental health care field. The present article reviews broad similarities and differences between each tradition while acknowledging that such generalizations may overlook heterogeneity within each. However, it is believed that a comparison between CBT and PDT is beneficial in dispelling myths about each tradition, fostering dialogue, encouraging further scholarship and research. While not an exhaustive account, this article will examine how CBT and PDT differ in how they view several topics such as the unconscious, the therapeutic alliance, the role of homework, symptom reduction, and therapeutic heuristics. Commentary is also offered on how research may be more effectively and collaboratively integrated with clinical work from both traditions. Future directions for partnership and improving mental health treatments are also discussed.

Sexual minority reflections on their psychotherapy experiences

OBJECTIVE

Sexual minority (lesbian, gay, bisexual, queer) individuals are regular consumers of psychotherapy, and are more likely to utilize psychotherapy than heterosexually identified individuals. However, there is scant research on sexual minority clients examining their perceptions of therapists' efforts to work successfully with them.

METHOD

We examined the experiences reported by sexual minority individuals in psychotherapy (N = 77), utilizing an Internet-based survey that asked open-ended questions such as, "How did your therapist address your sexual orientation?"

RESULT

Using directed content analysis, we derived 19 repeating ideas, which we categorized into five major themes and two overarching concepts, including: (a) participants reported appreciating general person-centered psychotherapy competencies (e.g., active listening, validation, Socratic questioning) and (b) participants reported that various aspects of sexual orientation (e.g., therapist sexual identity, therapist knowledge about sexual minority populations) are relevant to their experiences in therapy and should be addressed directly by therapists.

CONCLUSIONS

Results indicated that clients want generally competent therapists who understand that a sexual minority identity is only one part of a client's overall identity and not a defining characteristic or psychopathological. We explicate themes and representative quotes, and provide preliminary recommendations for therapists working with sexual minority clients.

A Professional Journey Through Life

In response to the request to write about those changes that have occurred in my professional outlook and practice that have come with age, I have recounted some of the experiences I have had that seem to have contributed to these changes. There are a couple of important themes that have run through my professional experiences as a therapist, supervisor, teacher, and researcher. One of the themes has to do with my psychotherapy orientation. The other involves the tension that I have experienced between research and practice. I begin by discussing each of these, and then go on to highlight some of the more general lessons learned over the years, including coming to be more myself as a therapist, developing a broader perspective on life, being more clinically integrative, and learning to be accepting of what therapy can and cannot do.

Informal discussions in substance abuse treatment sessions with Spanish-speaking clients

This study investigated the extent to which bilingual counselors initiated informal discussions about topics that were unrelated to the treatment of their monolingual Spanish-speaking Hispanic clients in a National Institute on Drug Abuse Clinical Trial Network protocol examining the effectiveness of motivational enhancement therapy (MET). Session audiotapes were independently rated to assess counselor treatment fidelity and the incidence of informal discussions. Eighty-three percent of the 23 counselors participating in the trial initiated informal discussions at least once in one or more of their sessions. Counselors delivering MET in the trial initiated informal discussion significantly less often than the counselors delivering standard treatment. Counselors delivering standard treatment were likely to talk informally the most when they were ethnically non-Latin. In addition, informal discussion was found to have significant inverse correlations with client motivation to reduce substance use and client retention in treatment. These results suggest that informal discussion may have adverse consequences on Hispanic clients' motivation for change and substance abuse treatment outcomes and that maintaining a more formal relationship in early treatment sessions may work best with Hispanic clients. Careful counselor training and supervision in MET may suppress the tendency of counselors to talk informally in sessions.

The use of therapist self-disclosure: clinical psychology trainees' experiences

This qualitative study examined clinical psychology trainees' experiences of using, or not using, therapist self-disclosure and their experience of training and supervision on this issue. Fourteen trainees were interviewed and their accounts analyzed using interpretative phenomenological analysis, yielding nine themes organized into two domains. The first domain ("the decision in the moment") concerned participants' struggle with decision making about disclosure; the second ("the developing therapist") reflected their evolving ideas about disclosure over training and within the wider philosophical context of therapy. The dilemmas surrounding disclosure seemed to distill some central issues associated with participants' developing professional therapist identity. Working out one's position on self-disclosure is a challenge that trainee therapists may require support in mastering.

Informal discussions in substance abuse treatment sessions

This study evaluated the extent to which counselors initiated informal discussions (i.e., general discussions and self-disclosures about matters unrelated to treatment) with their clients during treatment sessions within two National Institute on Drug Abuse Clinical Trial Network protocols involving adaptations of motivational interviewing (MI). Sixty counselors across the two protocols had 736 sessions independently rated for counselor treatment fidelity and the occurrence of informal discussions. The results showed that 88% of the counselors initiated informal discussions in their sessions and that most of these discussions involved counselors sharing personal information or experiences they had in common with their clients. The major finding was that counselor training in MI was associated with significantly less informal discussion across sessions. A higher frequency of informal discussion was related to less counselor MI proficiency and less in-session change in client motivation, although unrelated to client program retention and substance use outcomes. The findings suggest that although some informal discussions may help build an alliance between counselors and clients, too much of it may hinder counselors' proficient implementation of MI treatment strategies and the clients' motivational enhancement process.

Therapist self-disclosure: research-based suggestions for practitioners

After defining therapist self-disclosure, we briefly discuss its theoretical foundations. We then move to our primary focus of presenting a number of suggestions for effective use of therapist self-disclosure, based on the extant empirical literature.

Self-disclosure in psychotherapy practice and supervision: an introduction

Disclosure in psychotherapy may be considered from multiple perspectives: therapist to patient, patient to therapist, trainee to supervisor, and supervisor to trainee. Individuals in each of these roles must decide if, when, and how they should articulate certain thoughts or feelings to their therapeutic counterpart. Multicultural considerations may well influence these decisions. The articles in this issue, including two that are research reviews, question the value and parameters of self-disclosure in each of these contexts; they speak to the inevitable tension within psychotherapeutic dyads between the demands of open and honest disclosures and the equally potent countervailing forces of shame, tact, and appropriateness.

The many faces of self-disclosure

The contributions of eight authors to this issue of In Session are discussed, with emphasis on who discloses what to whom, in what ways, and for what reasons. The primary conclusions concern the varieties of self-disclosure, the motives for self-disclosure, the appropriate outcome variable in studying self-disclosure, the value of evidence, the importance of the context, and the crucial role of the relationship. Self-disclosure, properly used, can be a significant contributor to successful psychotherapy.