Happy Chinese New Year (Gung Hay Fat Choy!). As you can see from the photo, I attended the New Year’s parade in San Francisco’s Chinatown this year. This disclosure introduces my topic for today, directed toward patients and would-be patients: Why do therapists disclose so little about ourselves? Why all the secrecy?
The standard answer goes as follows. Traditional psychodynamic psychotherapy, the kind that evolved from Freudian psychoanalysis, derives much of its healing power from observing and analyzing the transference. Transference is a complex concept, but for our purpose it can be understood as interpersonal attitudes and expectations learned early in life, that the patient unconsciously applies (“transfers”) to the therapist. These unconscious expectations can be positive, as in assuming the therapist will be loving, selfless, and perhaps superhuman, and/or negative, as in assuming the therapist will be withholding, competitive, or shaming. The nature of a patient’s transference reveals a great deal about how he or she sees others. ”Interpreting the transference” — making these unconscious assumptions conscious — frees the patient to treat self and other more realistically.
For this reason, anything in dynamic psychotherapy that promotes transference, and leaves it in its unperturbed natural state for observation, helps move the process along. This is where Freud’s “tabula rasa” or blank slate idea originates. The less known about the therapist, the more the patient fills in the blanks with transference. According to this view, it is more helpful to learn what the patient imagines about the therapist, than to correct the patient’s misperceptions or to share private details reciprocally.
However, there are several caveats that go with this idea. One is that not every patient in psychodynamic therapy handles frustration and delayed (or thwarted) gratification the same way. Some easily tolerate asking a question and not getting an answer, and enjoy exploring what their own minds come up with. At the other extreme are those who find the process insufferably insulting or humiliating, and cannot do this kind of work. In between are the majority who find therapist non-disclosure frustrating, but who can tolerate and work with it. In addition, patients (i.e., all of us) can shift day by day, or moment by moment, in our frustration tolerance and our willingness to “play” with our ideas and feelings in order to learn more about ourselves. A sensitive therapist recognizes this and responds accordingly.
An even more obvious caveat is that no therapist is truly a blank slate. If nothing else, patients know our race, gender, approximate age, and how we like to decorate the office. And let’s not kid ourselves, perceptive patients can soon guess or estimate details like socioeconomic status, regional dialects and accents, formality, conventionality, frustration tolerance, warmth, and a host of other therapist attributes. Moreover, we often reveal just by our look of recognition, or the lack of it, whether we are familiar with the book, movie, restaurant, cultural happening, or bit of street slang the patient just mentioned. And all this before the patient really gets curious and googles us.
The slate is far from blank. Still, therapists play what must seem like a sadistic guessing game to many patients: “You asked if I’m married [or gay, or have children, or watch 'The Sopranos']. What do you imagine about my home life?” I believe many times this exchange feels awkward and stilted for both parties, first, because the therapist does not explain the transference-based rationale behind the socially odd rejoinder, and second, because not answering also serves a boundary-setting function for the therapist, which is also not discussed. Often therapists themselves fail to distinguish these two aims.
I have supervised many beginning therapists who treat non-disclosure as a blindly followed rule about maintaining boundaries. Transference and even their own privacy are poorly articulated afterthoughts. (Conversely, I’ve met a few trainees who disclose freely in defiance of orthodoxy, and to make the therapist and patient “equal,” which they are not. Free and open disclosure by the therapist is compatible with perfectly good therapy — just not the psychodynamic variety that examines transference. It’s also not compatible with one’s own privacy, as discussed below.) With more experience, therapists pick and choose what to disclose, and the whole endeavor becomes less stilted and defensive on the part of the therapist, and more comprehensible to the patient. However, even very experienced therapists sometimes fail to explain to patients why they don’t answer personal questions directly. I see no harm, and much to gain, in offering a brief rationale.
The most important point about therapist self-disclosure is that the therapy is for the patient, not the therapist. Therapists who self-disclose because they like to tell stories or talk about themselves detract from the therapy they provide. They need another outlet (friends and family? a blog?). More subtle is disclosure aimed to make the patient like or respect the therapist. As a general guideline I disclose what I judge will benefit my patient, and not what I judge will not.
But there is a final point to be made about privacy. Being a patient in therapy feels — and is — vulnerable and exposing. It takes courage to bare one’s soul to someone who is initially a stranger; trust comes with time and must be earned. Efforts by either party to “even the playing field” through therapist self-disclosure cannot hasten this process or make it easier; the cost of such doomed effort is the therapist’s privacy. Many therapists have been in therapy ourselves, and that was when we were vulnerable. Good therapists owe their patients undivided attention, thoughtful reflection, concern, and empathy — but not an experience of false equality at the cost of their own privacy. I feel comfortable telling you I attended the Chinese New Year’s parade both because it won’t hamper our transference work if you happen to be my patient, and also because it isn’t very private. I consider both of these factors when a patient asks me a personal question.
Here is something that I do not understand. You say that the nature patient’s transference reveals a great deal about how he or she sees others. But doesn’t what it really reveal is a great deal about how the patient sees and treats others that the patient doesn’t know, or has to talk to for the first time? I can see how that might be helpful in the business world, where a lot of times you are talking to people once and then never again. But in the world of family, friends, and love, where relationships grow and deepen mutually? How is knowledge of transference at all helpful?
Hi Mariah, thanks for writing. I agree that transference as observed in therapy most closely mirrors the patient’s feelings toward others in “real life” who are relatively unknown. When others are better known, transference may have less of a role. However, transference exists in all relationships, and can have subtle but important effects even with others who are not “blank slates.”
The traditional therapy relationship isn’t set up to mimic any particular relationship outside of therapy. It is set up, in large part, to highlight the patient’s personality. By definition, personality consists of patient attributes that tend to persist across different situations. We all relate differently to different people, yet therapy looks for common personality threads that underlie these encounters. These threads may be prominent in some situations and more obscure in others. But therapy only aims to help persons change themselves, not the people around them. So knowledge of personality, in part through observing transference, is exactly the kind of discovery that can help a person across many different interpersonal encounters.
Variations on your question have come up before, so I should post a longer piece on this. Thanks again for writing.
Okay, I have read this on your recommendation after I commented on your counter transference blog. I always figured that a therapist not answering personal questions was procedure. I never thought about how it would affect transference. I never really thought about transference as such a big part of therapy before. I know it plays a part in other aspects of life. It just naturally happens I guess. I don’t really think I do that so much in therapy.. Thinking about it now. I just see my therapist as a doctor who is supposed to listen to my crazy thoughts, and make the sound not so crazy.
Yes, I will admit I google all my Psychiatrists (and everyone else including myself haha). I like to see what schools they went to, and what kind of work they did. I had one therapist who I goggled and found out she was like the ultimate master data base on sleep. That’s what she worked on in school. It’s also cool to see what awards they have. I wouldn’t be surprised if you doctors googled us as well. As far as personal questions. I respect their privacy. They also respect mine when I don’t want to talk about stuff. Although sometimes that is a bad thing. The main thing I want to know about my therapists is do they have kids, and where they are from. I don’t think that is terribly personal.
I do want my therapist to be a little relatable. That’s why I ask if they have kids. I have a lot of issues with my parents, and it makes me a little more comfortable talking to someone who has kids. My therapist now Is a male who has kids, and I have been able to trust him, and open up about a lot of things I have never opened up about before. That in itself is transference I guess, but had he declined to answer or got all upset when I asked him, therapy would have gone a very different way or may not have gone at all. He did ask me why I wanted to know, and i told him, so he answered. Fair trade, I think. He used his judgement, and did a fair job reading me. It was helpful.
I have had therapists Where in the first session they would ask the typical questions: tell me about yourself what are your goals, what types of therapy have you done before, do you take meds etc. Then they ask do you have any questions for me. I ask simply so where are you from somewhere around here? The therapist completely clams up and Gets nervous and is kinda freaking out. That sends me running. It’s not like I am asking for you address. Just are you from around here? The left coast maybe? New England? Just o you have kids, not how old are the what are their names and how many. If the therapist wants to say more that’s up to them.
The therapist does need to use his or her judgement about what is best to disclose. Every patient is different. Every therapist is different. From a personal perspectiveI feel a little more comfortable knowing a few simple, basic things about my therapist. Just trying to settle the nerves during that first session. You can’t leave absolutely everything to the imagination though.
That was informative. Thank you for suggesting I read that. I have a new found appreciation for transference in therapy.
~Catrenia
[...] asked whether I’d ever been in therapy myself. Without answering his question directly (see my thoughts on psychotherapist disclosure and privacy), I replied that many of us have, and asked what it meant to him. It would be a bad sign: [...]
Hi Doctor Reidbord
Reading your blog entry above. I felt I had to comment. First, some disclosure on my part: I have been in therapy for many years. I I have been to various therapists, a Horneyan, a Sullivanian, a Modern Analyst (Spotnitz based), and Albert Ellis himself, among others.
While I agree with you about the importance of transference and counter-transference in many kinds of therapy, I believe that they play a part in all relationships and will have an effect even if the patient does know about the therapist. Ellis, of course, discounted it’s importance completely. I found both schools of thought helpful personally.
However, I think it is important to introduce a significant idea into the discussion, that of consumer’s rights. As an intelligent and educated person, I feel it is my right to have an idea of my therapists training, professional experience and general life experience. If I am having problems raising my children, I believe I am better served by a therapist who has been a successful parent, for example. This is not always true, but often is. I at least want to have the option of knowing whether or not the therapist has the qualifications to help me, just as I would if I were going to a surgeon or an auto-mechanic or an art teacher.
At the first interview, when the person being interviewed is not yet a client, I believe simple, respectful answers on the part of the therapist are called for. In many cases, might this not be the beginning of an ego-strengthening process? I understand that in an analytic based therapy this may not always be appropriate, but I wonder if the mystification around simple human interaction damages the patient and the profession.
Hi, and thanks for writing. I agree that transference and countertransference play a part in all relationships, yet only in analytic based therapies are the associated feelings used therapeutically. Ellis is joined by practitioners of many other schools in discounting their importance.
Your point about consumer’s rights is important but complicated. At the level of formal professional qualifications you’ll face no argument from even the most orthodox psychoanalyst. A “consumer” should know whether an MD is trained as a psychiatrist, whether a psychologist has masters or doctoral level training, whether a clinical social worker is licensed to practice. This type of information is often available publicly. You can look me up on the California Medical Board website and see that I’m a licensed MD who finished medical school in 1985. Other official sites show I was board-certified in psychiatry in 1991.
Whether I’m a successful parent is a different kind of question. It’s about my personal life, not what I do at the office. It’s not a question you’d ask a surgeon, auto mechanic, or art teacher. It doesn’t bear directly on whether I might help your parenting issues: I may be able to help you even though I couldn’t help myself (there are many great coaches who can’t play ball); factors outside my control may have made my own parenting “unsuccessful”; your issues with parenting may be different than my issues.
Aside from the utility of the question is the problem of line drawing. Are those seeking sex therapy entitled to know the details of my sex life? Since topics discussed in psychotherapy can cover the whole of human experience, I would in theory need to be a completely open book to any patient who sought to check my “qualifications”. I confess that I see no clear line between public and private, especially now in the age of Facebook and Twitter. But there has to be a line somewhere, and analytic therapists tend to draw it somewhat more restrictively than other types of therapists. As I’m sure you’re aware, this is not done in the interest of abridging “consumer rights,” but to foster the phenomena that can lead to insight and change.
Thank you for this article. I am a clinical psychologist. I was trained in psycho-dynamic principles with a focus on transference and counter-transference, but now living in a country where CBT is king. I would like to add few thoughts:
1. Your article addresses the issues of transference and disclosure. Obviously these ideas are related but they are also discrete issues. The therapist can self-disclose and still work in the transference.
2. Despite Ellis’ rejection of transference, there is a growing acknowledgement that therapists need to be mindful of this dynamic regardless of their primary orientation (see “Transference and Countertransference in Non-Analytic Therapy”; Judith A. Schaeffer (2007) University Press of America).
3. The issue of therapist self-disclosure and transference is less complete without a consideration of the counter-transference. A therapist who self-discloses without first thinking through why they are doing it (own need vs it serving a therapeutic goal)is jeopardizing the therapy. By contrast, if the therapist is sufficiently aware of their own dynamics – including their counter-transference reaction to the client – is conscious of what they are disclosing and why, AND would feel comfortable talking about it in supervision, their disclosure is more likely to be ethical and constructive.
I appreciate your thoughtful points and agree with each of them. To embellish further:
1. While transference would arise even toward an “open book” therapist (as it does in human interactions generally), it’s harder to see and appreciate. Thus, unthinking or reflexive self-disclosure interferes with transference work. Obviously, all psychotherapists self-disclose to some extent. I see this as a matter of degree, and in many instances it constitutes a trade-off between empathic connection and analytic exploration. Selective self-disclosure improves with clinician experience, too: One learns what is helpful and what isn’t.
2. I too have heard of a growing recognition of transference and countertransference in non-analytic therapy. However, analytic/dynamic therapies remain the only ones that employ transference as a therapeutic tool.
3. I agree, sensitive attention to countertransference is key. See this post for further thoughts on countertransference.
Thanks for writing.
What a wonderful, thoughtful article. My therapist has never chatted–if she did, I’d feel cheated. After all, therapy is primarily about me and, sorry, I pay good money. Sometimes I have been curious about her and would like to know just a little bit more her. However, what matters to me more than anything is that she is present WITH me every second, it seems, of our session, and her empathy, compassion, patience and perseverance have helped transform my life. For instance, after months of observing me being unable to mourn my mother’s death she gently told me her own experience of being with her mother as her mother died. This self-disclosure became a crucial turning point in my therapy, the point at which I began to face and learn to be with my own feelings–and it was a crucial step towards firming up our alliance and my trust. It seems to me that used sparingly and selectively, self-disclosure can support a patient’s trust and thus the course of therapy.
Thank you very much for such a thoughtful article. I come from a very peculiar experience, having spent a good couple of years listening to embarrassingly detailed accounts of my Gestalt therapist’s life: literally, he sometimes did much of the talk, and I was left to ask “Yes, but what has all this to do with me?”. There followed some explanations about building a relationship of trust and fostering motivation, but I ended up just finding it all pointless and counterproductive, not to mention shamefully expensive.
Thankfully, if a little belatedly, I was able to quit that therapy, and I am now seeing a CB therapist whom I find much more professional in that sense. I remembering asking him to not disclose literally anything to me, something that I now realize was not at all necessary. I do feel listened to, taken seriously and valued now, and I am now building an effective therapeutic ‘alliance’ that has allowed me a much more thorough sense of wellbeing. I can see now my transference at work, entrusting him to help me value my experience, thoughts and emotions, and to accompany me in making some of the changes I feel I need.
Once I, a psychologist, went to a doctor for a routine check up and found myself listening to all his personal information and problems. I did not return.
Hello Dr Reidbord, I read your article on transference and it is indeed very interesting, although not depicting exactly the full spectrum of feelings emerging in front of the therapist’s unwillingness to answer questions. Being in therapy for many years i still don’t see why all that mystery, i think it impedes my own therapy and feelings.
I would like to ask you to explain more on how the transference acts therapeutically if i as a person and patient have already told my therapist that i have numerous obsessions about people when i am in love with them and i can’t predict what they think about me or how they spend their lives which might seem trivial but for me is important. I have already delineated, described and analysed a great part of my fantasies and curiosity on other people with the help of my therapist so I don’t exactly see the reason why I should confront with this issue once again and during the therapy itself.
Hi Alanis,
As I wrote in the original piece, transference work isn’t for everyone. Or more accurately, it’s a matter of degree. It may be too upsetting or unnerving for you as practiced by your therapist, something that can only be worked out between the two of you. I can’t help but mention, though, that “telling” your therapist about your issues and “delineating, describing and analyzing” them together isn’t the same thing as working in the transference. The goal is not an intellectual understanding of what is going on, nor making sure your therapist knows. It’s an emotional experiencing of these unpleasant feelings in the therapeutic relationship that allows you to observe yourself feeling them. The fact that you continue to struggle with your fantasies and curiosity about other people is reason enough to continue to work on this issue, either in transference work or some other modality of therapy.
I edited out the second part of your comment per your request. This is not the sort of advice that anyone on the internet can give you; I can only refer you back to your own therapist. Also, I do not offer personal replies by email, sorry. Thank you for writing.